Sudden Death in Epilepsy PDF

Preface

This is our third book focused on the clinical problem of sudden unexpected death in epilepsy (SUDEP). We explore and highlight our new SUDEP Classification System and present a new method called "SUDEP Risk Factor Cluster ID" in this book. Our method evaluates likely mechanisms of and risk factors for premature death in individuals with epilepsy. SUDEP is thought to be a heterogeneous syndrome with multiple causes and mechanisms, including central and peripheral roles for the brain, heart and arrhythmias, respiratory system with both central and obstructive apnea, as well as unknown mechanisms. Different mechanisms of SUDEP may apply to different patients, implying that their risk factors will differ. The ultimate goal of our approach is a better ability to individualize risk for SUDEP and therefore better individual patient management, such as selection of AEDs and other preventive strategies.

Case histories of SUDEP, definite or probable, as well as near miss cases are included in the book with illustrative SUDEP Cluster IDs. One chapter addresses how to use selflearning techniques and apply this new method to patients with epilepsy. Patient management is discussed. A number of other chapters demonstrate how to use our new method of SUDEP Risk Factor analysis, which will allow neurologists, emergency room physicians, and attending physicians to identify individuals at risk for SUDEP and hopefully lessen the chance of occurrence. Our book can therefore be used to teach the public, professionals, and students about the risk factors for SUDEP.

Our SUDEP Risk Factor Classification and Cluster ID method and its use to evaluate 115 cases of SUDEP are presented. We have begun to develop an international database of human cases and animal models of SUDEP. We demonstrate how medical examiners' and coroners' offices can provide information about SUDEP victims to strengthen the foundation of the database. It is our hope that physicians will use our SUDEP database to determine the level of risk of patients with similar Cluster IDs.

We present related clinical and animal studies needed to classify risk factors for SUDEP victims.

Further clinical, epidemiological, genetic, and many other studies are needed to identify underlying pathophysiologic mechanisms. All of our collaborators and coauthors are working on related clinical or animal studies to classify risk factors for SUDEP for use with our Risk Factor Cluster IDs. We are building the new SUDEP classification system and SUDEP Risk Factor Cluster IDs in the hope that they will transform the care of patients who are at risk for SUDEP.