So Elson L
Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Epilepsia. 2008 Dec;49 Suppl 9:93-8. doi: 10.1111/j.1528-1167.2008.01932.x.
This article highlights studies in three major domains of potential mechanisms of sudden unexplained death in epilepsy (SUDEP): cardiac, respiratory, and autonomic. Ictal cardiac arrest is a clinically rare but well-recognized potential mechanism of SUDEP. Studies have failed to identify preexisting cardiac electrophysiologic or structural abnormalities that distinguish SUDEP persons. Some degree of pulmonary congestion is a common autopsy finding, but severe pulmonary edema occurs very rarely with seizures. In contrast, periictal apnea and hypoxia occur commonly with generalized tonic-clonic seizures and, to a lesser degree, with complex partial seizures. There are several animal models of postictal respiratory arrest. Postictal respiratory arrest in audiogenic seizure mice can be induced by serotonin receptor inhibition or prevented by selective serotonin reuptake inhibitor (SSRI) drugs. Reduced heart rate variability occurs in patients with refractory epilepsy and can be induced in animal seizure models, but its precise role in predisposing persons to sudden death requires further investigation.
本文重点介绍了癫痫不明原因猝死（SUDEP）潜在机制的三个主要领域的研究：心脏、呼吸和自主神经。发作期心脏骤停是临床上罕见但已得到充分认识的SUDEP潜在机制。研究未能识别出区分SUDEP患者的既往存在的心脏电生理或结构异常。一定程度的肺淤血是常见的尸检发现，但严重肺水肿在癫痫发作时非常罕见。相比之下，发作期呼吸暂停和低氧血症在全身性强直阵挛发作时常见，在复杂部分性发作时程度较轻。有几种发作后呼吸骤停的动物模型。声源性癫痫小鼠的发作后呼吸骤停可通过抑制血清素受体诱导，或通过选择性血清素再摄取抑制剂（SSRI）药物预防。难治性癫痫患者心率变异性降低，在动物癫痫模型中也可诱导出现，但其在使人易发生猝死的确切作用尚需进一步研究。
