癫痫监测单元中心跳呼吸骤停的发生率和机制（MORTEMUS）：一项回顾性研究。

Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study.

机构信息

Hospices Civils de Lyon and CRNL, INSERM U1028, CNRS 5292, Lyon, France.

出版信息

Lancet Neurol. 2013 Oct;12(10):966-77. doi: 10.1016/S1474-4422(13)70214-X. Epub 2013 Sep 4.

DOI:10.1016/S1474-4422(13)70214-X

PMID:24012372

Abstract

BACKGROUND

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide.

METHODS

Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available.

FINDINGS

147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95% CI 2·6-9·2) per 1000 patient-years, with a risk of 1·2 (0·6-2·1) per 10,000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal.

INTERPRETATION

SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time.

FUNDING

Commission of European Affairs of the International League Against Epilepsy.

摘要

背景

癫痫猝死（SUDEP）是慢性难治性癫痫患者死亡的主要原因。在癫痫监测病房中，SUDEP 极为罕见，但为其仍然难以捉摸的病理生理学提供了极具价值的信息。MORTEMUS 研究通过对全球癫痫监测病房中遇到的心肺骤停进行全面评估，扩展了这些数据。

方法

在 2008 年 1 月 1 日至 2009 年 12 月 29 日期间，我们对位于欧洲、以色列、澳大利亚和新西兰的癫痫监测病房进行了系统的回顾性调查，以检索这些病房记录的所有心肺骤停数据，并估算其发生率。还邀请其他地区的癫痫监测病房报告类似病例，以进一步探讨其机制。一个专家小组审查了数据，包括视频脑电图（VEEG）和当时心肺骤停时的心电图资料（只要有资料）。

结果

160 个病房中的 147 个（92%）对调查做出了回应。报告了 29 例心肺骤停，包括 16 例 SUDEP（14 例发生在夜间）、9 例接近 SUDEP 和 4 例其他原因死亡。对 10 例 SUDEP 的心肺数据进行了评估，发现存在一种一致的、以前未被识别的模式，即在继发性全面强直阵挛发作后出现快速呼吸（18-50 次/分），随后在 3 分钟内出现短暂或终末心肺功能障碍。这种功能障碍是短暂的，随后在发作结束后 11 分钟内出现终末呼吸暂停和心脏骤停。成人癫痫监测病房的 SUDEP 发生率为每 1000 患者年 5.1（95%CI 2.6-9.2），每 10000 次 VEEG 监测发生 1.2（0.6-2.1）例，可能与监测不足和（或）抗癫痫药物停药有关。