1st Edition

Sudden Death in Epilepsy Forensic and Clinical Issues

    1047 Pages 177 B/W Illustrations
    by CRC Press

    Though it is one of the most common causes of death in epilepsy patients, SUDEP is still infrequently and even reluctantly named on autopsy reports. This under-reporting equates to a lack of attention and earnest investigation into the cause, predisposition, and prevention of SUDEP. There is as yet little effort to establish an actionable strategy in the mitigation of these potentially fatal arrhythmias.

    Expanding on the 1990 book Epilepsy and Sudden Death, edited by Lathers and Schraeder, Sudden Death in Epilepsy: Forensic and Clinical Issues reviews of the basic science of epilepsy as it relates to SUDEP. Clinical chapters study the sophisticated simultaneous ambulatory EKG and EEG telemetry and respiratory function monitoring of patients at risk for sudden death that will help identify cardiac, respiratory, and epileptogenic interactions involved. Chapters on animal models evaluate new data from studies that build on previously used models and emphasize that multiple models are needed to investigate the pathophysiology of SUDEP, to hypothesize about effective treatments, to develop pilot studies in persons with epilepsy, and to conduct confirmatory large-scale clinical trials.

    Contributions discuss the interaction between the central and peripheral autonomic nervous systems and the cardiopulmonary systems; proposed mechanistic factors in SUDEP; risk categories of arrhythmogenic, respiratory, and hypoxia related cardiac death; psychological, emotional, and stress related factors; the role of alcohol and drugs in seizures; and the potential mitigating properties of antiepileptic medication.

    Adopting a global, multidisciplinary focus to address the mystery of SUDEP, this important work provides clinicians, researchers, patients, and families with the knowledge to freely discuss the phenomenon and thereby discover the preventive treatment regimens to decrease the occurrence of SUDEP.

    Forensics of Sudden Death
    Neurocardiologic Mechanistic Risk Factors in Sudden Unexpected Death in Epilepsy: C.M. Lathers, P.L. Schraeder, and M.W. Bungo
    Forensic Considerations and Sudden Unexpected Death in Epilepsy: J.E. Leestma
    Omega-3 Fatty Acids in Sudden Unexpected Death in Epilepsy: Guardian of the Brain–Heart Connection: F.A. Scorza, E.A. Cavalheiro, R.M. Arida, V.C. Terra, C.A. Scorza, E.Y.F. Sonoda and R.M. Cysneiros
    Unanswered Questions: SUDEP Studies Needed: C.M. Lathers, P.L. Schraeder and M.W. Bungo
    Medullary Serotonergic Abnormalities in Sudden Infant Death Syndrome: Implications in SUDEP: D.S. Paterson
    Forensic Case Identification: P.L. Schraeder, E.L. So and C.M. Lathers
    Sudden Unexpected Death in Epilepsy: Future Research Directions: S. Parvulescu-Codrea
    Forensic Postmortem Examination of Victims of Sudden Unexpected Death in Epilepsy: C.M. Lathers, P.L. Schraeder, S.A. Koehler and C.H. Wecht
    One-Year Postmortem Forensic Analysis of Deaths in Persons with Epilepsy: S.A. Koehler, P.L. Schraeder, C.M. Lathers and C.H. Wecht
    Drug Abuse and SUDEP: S.B. Karch
    Cocaine-Induced Seizures, Arrhythmias, and Sudden Death: C.M. Lathers, M.M. Spino, I. Agarwal, L.S.Y. Tyau and W.B. Pickworth
    Risk Factors for Sudden Death in Epilepsy: T. Walczak
    EEG Findings in SUDEP: M. Nei and N. Simpkins
    Severity of Seizures as a Forensic Risk and Case Reports: E.H. Maa, M.P. Earnest, M.C. Spitz and J. Bainbridge
    Intractable Epilepsy in the Setting of Malformations of Cortical Development as a Mechanism for SUDEP: L. Jehi and I. Najm
    Neurogenic Cardiac Arrhythmias: H. Leung and A.Y.Y. Chan
    Stress and SUDEP: C.M. Lathers and P.L. Schraeder
    Genetics of Sudden Death in Epilepsy: N. Ghali and L. Nashef
    Cardiac Channelopathies and Sudden Death: B. Herreros
    Sodium Channel Dysfunction Common Physiopathologic Mechanism Associated with Sudden Death ECG Abnormalities in Brugada Syndrome and Some Types of Epilepsy: Case Histories: C.M. Lathers, P.L. Schraeder and M.W. Bungo
    Not Seizure but Syncope: S. Sharma, T. Ho and B.K. Kantharia
    Syncope, Seizures, and SUDEP: Case Histories: C.M. Lathers, P.L. Schraeder and M.W. Bungo
    Sudden Death in Epilepsy: Relationship to the Sleep–Wake Circadian Cycle and Fractal Physiology: J.D. Hughes and S. Sato
    SUDEP: Medicolegal and Clinical Experiences: B.B. Wannamaker

    SUDEP Animal Models
    MECHANISMS OF RISKS
    Sudden Death: Animal Models to Study Nervous System Sites of Action for Disease and Pharmacological Intervention: C.M. Lathers
    Synaptic Plasticity of Autonomic Ganglia: Role of Chronic Stress and Implication in Cardiovascular Diseases and Sudden Death: K.A. Alkadhi and K.H. Alzoubi
    Animal Model for Sudden Cardiac Death: Autonomic Cardiac Sympathetic Nonuniform Neural Discharge: C.M. Lathers
    Animal Model for Sudden Unexpected Death in Persons with Epilepsy: C.M. Lathers and P.L. Schraeder
    A Characterization of the Lockstep Phenomenon in Phenobarbital-Pretreated Cats: J.M. Dodd-O and C.M. Lathers
    Relationship of the Lockstep Phenomenon and Precipitous Changes in Blood Pressure: A.Z. Stauffer, J.M. D.O and C.M. Lathers
    Interspike Interval Histogram Characterization of Synchronized Cardiac Sympathetic Neural Discharge and Epileptogenic Activity in the Electrocorticogram of the Cat: D.K. O’Rourke and C.M. Lathers
    Power Spectral Analysis: A Procedure for Assessing Autonomic Activity Related to Risk Factors for Sudden and Unexplained Death in Epilepsy: S.R. Quint, J.A. Messenheimer and M.B. Tennison
    Animal Model for Sudden Cardiac Death: Sympathetic Innervation and Myocardial Beta-Receptor Densities: C.M. Lathers and R.M. Levin
    Antiepileptic Activity of Beta-Blocking Agents: C.M. Lathers, K.F. Jim, W.H. Spivey, C. Kahn, K. Dolce and W.D. Matthews
    Arrhythmias Associated with Epileptogenic Activity Elicited by Penicillin: C.M. Lathers and P.L. Schraeder
    Role of Neuropeptides in the Production of Epileptogenic Activity and Arrhythmias: C.M. Lathers
    Sudden Epileptic Death in Experimental Animal Models: O. Mameli and M.A. Caria
    Sympathetic Nervous System Dysregulation of Cardiac Function and Myocyte Potassium Channel Remodeling in Rodent Seizure Models: Candidate Mechanisms for SUDEP: S.L. Bealer, C.S. Metcalf, J.G. Little, M. Vatta, A. Brewster and A. Anderson
    The Urethane/Kainate Seizure Model as a Tool to Explore Physiology and Death Associated with Seizures: M. Stewart
    Acute Cardiovascular Response during Kindled Seizures: J.H. Goodman, R.W. Homan and I.L. Crawford
    DBA Mice as Models of Sudden Unexpected Death in Epilepsy: C.L. Faingold, S. Tupal, Y. Mhaskar and V.V. Uteshev

    Clinical Issues of Sudden Death
    Cardiac and Pulmonary Risk Factors and Pathomechanisms of Sudden Unexplained Death in Epilepsy Patients: J. Finsterer and C. Stöllberger
    Neurocardiac Interactions in Sudden Unexpected Death in Epilepsy: Can Ambulatory Electrocardiogram-Based Assessment of Autonomic Function and T-Wave Alternans Help to Evaluate Risk?: R.L. Verrier and S.C. Schachter
    Arrhythmogenic, Respiratory, and Psychological Risk Factors for Sudden Unexpected Death and Epilepsy: Case Histories: C.M. Lathers
    Sudden Arrhythmic Death Syndrome: Underlying Cardiac Etiologies, Their Implications, and the Overlap with SUDEP: P.S. Dhillon and E.R. Behr
    Odds Ratios Study of Antiepileptic Drugs: A Possible Approach to SUD EP Prevention?: C.M. Lathers, P.L. Schraeder and H.G. Claycamp
    Antiepileptic Drugs Benefit/Risk Clinical Pharmacology: Possible Role in Cause and/or Prevention of SUDEP: C.M. Lathers and P.L. Schraeder
    Clinical Pharmacology and SUDEP: C.M. Lathers and P.L. Schraeder
    Experience-Based Teaching of Therapeutics and Clinical Pharmacology of Antiepileptic Drugs: Sudden Unexplained Death in Epilepsy: Do Antiepileptic Drugs Have a Role?: C.M. Lathers and P.L. Schraeder
    Clinical Pharmacology of Antiepileptic Drug Use: Clinical Pearls about the Perils of Patty: P.L. Schraeder and C.M. Lathers
    Compliance with Antiepileptic Drug Treatment and the Risk of Sudden Unexpected Death in Epilepsy: T. Tomson
    SUDEP Clinical Case Histories: Typical and Atypical: P.L. Schraeder
    Cardiac Antiarrhythmic Agents: Pharmacological Basis for their Antiarrhythmic and Proarrhythmic Effects: S. Sharma, T. Ho and B.K. Kantharia
    Could Beta–Blocker Antiarrhythmic and Antiseizure Activity Help Prevent SUD EP?: C.M. Lathers
    Decision Analysis and Risk Management: H.G. Claycamp
    Epilepsy Surgery and the Prevention of SUDEP: R.S. Hays and M.R. Sperling
    Challenges in Overcoming Ethical, Legal, and Communication Barriers in SUDEP: J. Hanna and R. Panelli
    Bereavement and Sudden Unexpected Death in Epilepsy: L. Nashef and L. Sahlholdt
    SUDEP: A Clinical and Communicative Conundrum: P.L. Schraeder and C.M. Lathers
    Epilepsy and SUD EP: Lessons Learned: Scientific and Clinical Experience: C.M. Lathers and P.L. Schraeder
    SUDEP: A Mystery Yet to Be Solved: C.M. Lathers and P.L. Schraeder
    Forensic Evidence and Expert Witnesses: Scientific Evidence: Getting It In and Keeping It Out: T.L. Bohan
    Index

    Biography

    Claire M. Lathers, Paul L. Schraeder, Michael Bungo, Jan E. Leestma

    Lathers and colleagues have produced a colossal and astonishingly comprehensive tome on a little-appreciated subject: sudden death in epilepsy (SUDEP). All physicians who have treated patients with severe epilepsy have experienced the anguish of losing a young patient to this ill-defined syndrome. This book addresses all the issues--from the clinical to the basic, from the forensic to the bereavement. Every physician who treats epilepsy will do well to draw from the extraordinary compilation of data and expertise in this volume.
    —Roger J. Porter, MD, ScD, Adjunct Professor of Neurology, University of Pennsylvania, Philadelphia and Adjunct Professor of Pharmacology, USUHS, Bethesda

    The book is a skilled amalgam of neuroscience, cardiology, and pharmacology, along with numerous illustrative case examples, and it will become much thumbed-through as it takes a place of prominence on this forensic pathologist’s bookshelf.
    —Gregory J. Davis, MD, FCAP, University of Kentucky College of Medicine, State Medical Examiner, Kentucky, in Et Cetera.