Department of Functional Neurology and IDEE, Neurological Hospital, Hospices Civils de Lyon and TIGER, CRNL, INSERM U1028, CNRS 5292, University Claude Bernard Lyon-1, Lyon, France.
Epilepsia. 2013 May;54 Suppl 2:23-8. doi: 10.1111/epi.12180.
Sudden unexpected death in epilepsy (SUDEP) represents one of the most severe consequences of drug-resistant epilepsy, for which no evidence-based prevention is available. Development of effective prevention will depend on the following: (1) better understanding of the pathophysiology of SUDEP to define the most appropriate targets of intervention, and (2) identification of risk factors for SUDEP that would allow for the design of feasible clinical trials to test targeted interventions in high-risk populations. The most important known risk factor is the occurrence and frequency of generalized tonic-clonic seizure (GTCS), a seizure type that triggers the majority of witnessed SUDEP. Therefore, one likely way to prevent SUDEP is to minimize the risk of GTCS with optimal medical management and patient education. However, whether one might prevent SUDEP in patients with refractory epilepsy by using more frequent review of antiepileptic treatment and earlier referral for presurgical evaluation, remains to be seen. Another hypothetical strategy to prevent SUDEP is to reduce the risk of GTCS-induced postictal respiratory distress. This might be achieved by using lattice pillow, providing nocturnal supervision, reinforcing interictal serotoninergic tone, and lowering opiate- or adenosine-induced postictal brainstem depression. Promising interventions can be tested first on surrogate markers, such as postictal hypoxia in epilepsy monitoring units (EMUs), before SUDEP trials can be implemented. EMU safety should also be improved to avoid SUDEP occurrence in that setting. Finally, the development of ambulatory SUDEP prevention devices should be encouraged but raises a number of unsolved issues.
癫痫猝死（SUDEP）是耐药性癫痫最严重的后果之一，目前尚无基于证据的预防方法。开发有效的预防方法将取决于以下两个方面：（1）更好地了解 SUDEP 的病理生理学，以确定最合适的干预目标；（2）确定 SUDEP 的危险因素，以便设计可行的临床试验，以在高危人群中测试针对目标的干预措施。最重要的已知危险因素是全面强直阵挛性发作（GTCS）的发生和频率，这种发作类型引发了大多数有目击者的 SUDEP。因此，预防 SUDEP 的一种可能方法是通过优化药物管理和患者教育，最大限度地降低 GTCS 的风险。然而，通过更频繁地审查抗癫痫治疗和更早地转介进行术前评估，是否可以预防难治性癫痫患者的 SUDEP，仍有待观察。另一种预防 SUDEP 的假设策略是降低 GTCS 引起的癫痫后呼吸窘迫的风险。这可以通过使用格子枕头、提供夜间监护、增强癫痫间期 5-羟色胺能张力和降低阿片类或腺苷引起的癫痫后脑干抑制来实现。有前途的干预措施可以首先在替代标志物上进行测试，例如癫痫监测单元（EMU）中的癫痫后缺氧，然后才能实施 SUDEP 试验。还应改善 EMU 的安全性，以避免在该环境中发生 SUDEP。最后，应鼓励开发可移动的 SUDEP 预防设备，但这引发了许多未解决的问题。
