TY - JOUR
T1 - Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS)
T2 - A retrospective study
AU - Ryvlin, Philippe
AU - Nashef, Lina
AU - Lhatoo, Samden D.
AU - Bateman, Lisa M.
AU - Bird, Jonathan
AU - Bleasel, Andrew
AU - Boon, Paul
AU - Crespel, Arielle
AU - Dworetzky, Barbara A.
AU - Høgenhaven, Hans
AU - Lerche, Holger
AU - Maillard, Louis
AU - Malter, Michael P.
AU - Marchal, Cecile
AU - Murthy, Jagarlapudi M.K.
AU - Nitsche, Michael
AU - Pataraia, Ekaterina
AU - Rabben, Terje
AU - Rheims, Sylvain
AU - Sadzot, Bernard
AU - Schulze-Bonhage, Andreas
AU - Seyal, Masud
AU - So, Elson L.
AU - Spitz, Mark
AU - Szucs, Anna
AU - Tan, Meng
AU - Tao, James X.
AU - Tomson, Torbjörn
N1 - Funding Information:
We thank Pascal Roy (HCL, Lyon, France) for his advice on statistical analysis, as well as all members of the MORTEMUS survey list ( appendix ). Data collection for the study was supported by a grant from the Commission of European Affairs of the International League Against Epilepsy.
PY - 2013/10
Y1 - 2013/10
N2 - Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods: Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings: 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95% CI 2·6-9·2) per 1000 patient-years, with a risk of 1·2 (0·6-2·1) per 10000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time. Funding: Commission of European Affairs of the International League Against Epilepsy.
AB - Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods: Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings: 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95% CI 2·6-9·2) per 1000 patient-years, with a risk of 1·2 (0·6-2·1) per 10000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time. Funding: Commission of European Affairs of the International League Against Epilepsy.
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UR - http://www.scopus.com/inward/citedby.url?scp=84884155544&partnerID=8YFLogxK
U2 - 10.1016/S1474-4422(13)70214-X
DO - 10.1016/S1474-4422(13)70214-X
M3 - Article
C2 - 24012372
AN - SCOPUS:84884155544
SN - 1474-4422
VL - 12
SP - 966
EP - 977
JO - The Lancet Neurology
JF - The Lancet Neurology
IS - 10
ER -