Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

Levi P Sowers; Cory A Massey; Brian K Gehlbach; Mark A Granner; George B Richerson

doi:10.1016/j.resp.2013.05.010

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Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

Journal article

Peer reviewed

Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

Levi P Sowers, Cory A Massey, Brian K Gehlbach, Mark A Granner and George B Richerson

Respiratory physiology & neurobiology, Vol.189(2), pp.315-323

11/01/2013

DOI: 10.1016/j.resp.2013.05.010

PMCID: PMC4467545

PMID: 23707877

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http://doi.org/10.1016/j.resp.2013.05.010View

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Abstract

•SUDEP is the leading cause of death in epileptic patients.•Multiple mechanisms are thought to be involved, including respiratory dysfunction.•Serotonin is critical for control of breathing, chemoreception and arousal.•Defects in the serotonin system could be a contributing factor to SUDEP. Sudden unexplained death in epilepsy (SUDEP) is the cause of premature death of up to 17% of all patients with epilepsy and as many as 50% with chronic refractory epilepsy. However, SUDEP is not widely recognized to exist. The etiology of SUDEP remains unclear, but growing evidence points to peri-ictal respiratory, cardiac, or autonomic nervous system dysfunction. How seizures affect these systems remains uncertain. Here we focus on respiratory mechanisms believed to underlie SUDEP. We highlight clinical evidence that indicates peri-ictal hypoxemia occurs in a large percentage of patients due to central apnea, and identify the proposed anatomical regions of the brain governing these responses. In addition, we discuss animal models used to study peri-ictal respiratory depression. We highlight the role 5-HT neurons play in respiratory control, chemoreception, and arousal. Finally, we discuss the evidence that 5-HT deficits contribute to SUDEP and sudden infant death syndrome and the striking similarities between the two.

Death

Respiratory

Peri-ictal

SUDEP

Details

Title: Subtitle: Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms
Creators: Levi P Sowers - Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
Cory A Massey - Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
Brian K Gehlbach - Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
Mark A Granner - Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
George B Richerson - Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
Resource Type: Journal article
Publication Details: Respiratory physiology & neurobiology, Vol.189(2), pp.315-323
DOI: 10.1016/j.resp.2013.05.010
PMID: 23707877
PMCID: PMC4467545
NLM abbreviation: Respir Physiol Neurobiol
ISSN: 1569-9048
eISSN: 1878-1519
Publisher: Elsevier B.V
Language: English
Date published: 11/01/2013
Academic Unit: Neurology; Molecular Physiology and Biophysics; Pulmonary, Critical Care, and Occupational Medicine; Iowa Neuroscience Institute; Neurology (Pediatrics); Neurosurgery; Internal Medicine
Record Identifier: 9984013204902771

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