So Elson L
Section of Electroencephalography, Mayo Clinic, Rochester, Minnesota, USA.
Epilepsia. 2006;47 Suppl 1:87-92. doi: 10.1111/j.1528-1167.2006.00667.x.
The cause of sudden unexplained death in epilepsy (SUDEP) is still elusive, despite multiple studies over the past few decades. This review assesses recent progress in the understanding of risk factors (situations that predispose patients to SUDEP) and terminal events (events immediately associated with death) that potentially contribute to SUDEP. Recent studies strongly support a close relationship between seizure episodes (especially generalized convulsions) and SUDEP. The lethal nature of some seizure-induced cardiorespiratory events has been documented fortuitously in rare patient cases, and these events have been consistently reproduced in SUDEP animal models. Nonetheless, SUDEP likely does not have a single cause, and risk factors identified thus far may vary in importance among persons with epilepsy. In the absence of a complete understanding of the pathophysiologic mechanisms underlying SUDEP, potential preventive measures for high-risk patients are offered for consideration. Seizure control is most important for reducing SUDEP risk. Circumstantial data suggest that heightened supervision of patients with frequent seizures may be beneficial. Relatively simple interventions may be sufficient to interrupt potentially lethal events such as periictal suffocation or apnea. However, application of these preventive measures to all epilepsy patients has not been proven to substantially reduce the rate of SUDEP. Additional clinical and laboratory investigations are needed to identify and confirm pathogenic factors and preventive measures.
尽管在过去几十年里进行了多项研究，但癫痫性不明原因猝死（SUDEP）的病因仍然难以捉摸。本综述评估了在理解可能导致SUDEP的危险因素（使患者易患SUDEP的情况）和终末事件（与死亡直接相关的事件）方面的最新进展。最近的研究有力地支持了癫痫发作（尤其是全身性惊厥）与SUDEP之间的密切关系。一些癫痫诱发的心肺事件的致死性质在罕见的患者病例中偶然得到记录，并且这些事件在SUDEP动物模型中得到了一致的重现。尽管如此，SUDEP可能并非由单一原因引起，而且迄今为止确定的危险因素在癫痫患者中的重要性可能各不相同。在尚未完全了解SUDEP潜在病理生理机制的情况下，为高危患者提供了潜在的预防措施以供考虑。控制癫痫发作对于降低SUDEP风险最为重要。间接数据表明，加强对频繁发作患者的监护可能有益。相对简单的干预措施可能足以中断潜在的致命事件，如发作期窒息或呼吸暂停。然而，将这些预防措施应用于所有癫痫患者尚未被证明能显著降低SUDEP的发生率。需要进行更多的临床和实验室研究来识别和确认致病因素及预防措施。
