Nascimento Fábio A, Tseng Zian H, Palmiere Cristian, Maleszewski Joseph J, Shiomi Takayuki, McCrillis Aileen, Devinsky Orrin
Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, United States.
Epilepsy Behav. 2017 Aug;73:119-125. doi: 10.1016/j.yebeh.2017.05.013. Epub 2017 Jun 17.
To review studies on structural pulmonary and cardiac changes in SUDEP cases as well as studies showing pulmonary or cardiac structural changes in living epilepsy patients.
We conducted electronic literature searches using the PubMed database for articles published in English, regardless of publication year, that included data on cardiac and/or pulmonary structural abnormalities in SUDEP cases or in living epilepsy patients during the postictal period.
Fourteen postmortem studies reported pulmonary findings in SUDEP cases. Two focused mainly on assessing lung weights in SUDEP cases versus controls; no group difference was found. The other 12 reported descriptive autopsy findings. Among all SUDEP cases with available descriptive postmortem pulmonary examination, 72% had pulmonary changes, most often pulmonary edema/congestion, and, less frequently, intraalveolar hemorrhage. Eleven studies reported on cardiac pathology in SUDEP. Cardiac abnormalities were found in approximately one-fourth of cases. The most common findings were myocyte hypertrophy and myocardial fibrosis of various degrees. Among living epilepsy patients, postictal pulmonary pathology was the most commonly reported pulmonary abnormality and the most common postictal cardiac abnormality was transient left ventricular dysfunction - Takotsubo or neurogenic stunned myocardium.
Cardiac and pulmonary pathological abnormalities are frequent among SUDEP cases, most commonly pulmonary edema/congestion and focal interstitial myocardial fibrosis. Most findings are not quantified, with subjective elements and undefined interobserver reliability, and lack of controls such as matched epilepsy patients who died from other causes. Further, studies have not systematically evaluated potential confounding factors, including postmortem interval to autopsy, paramedic resuscitation and IV fluids administration, underlying heart/lung disease, and risk factors for cardiac or pulmonary disease. Prospective studies with controls are needed to define the heart and lung changes in SUDEP and understand their potential relationship to mechanisms of death in SUDEP.
回顾关于癫痫性猝死（SUDEP）病例肺部和心脏结构变化的研究，以及显示在世癫痫患者肺部或心脏结构变化的研究。
我们使用PubMed数据库进行电子文献检索，查找以英文发表的文章，不考虑发表年份，这些文章包含SUDEP病例或在世癫痫患者发作后期心脏和/或肺部结构异常的数据。
十四项尸检研究报告了SUDEP病例的肺部检查结果。两项研究主要关注评估SUDEP病例与对照组的肺重量；未发现组间差异。其他12项报告了描述性尸检结果。在所有有可用描述性尸检肺部检查的SUDEP病例中，72%有肺部变化，最常见的是肺水肿/充血，较少见的是肺泡内出血。十一项研究报告了SUDEP的心脏病理学。约四分之一的病例发现心脏异常。最常见的发现是不同程度的心肌肥大和心肌纤维化。在在世癫痫患者中，发作后期肺部病理学是最常报告的肺部异常，最常见的发作后期心脏异常是短暂性左心室功能障碍——应激性心肌病或神经源性心肌顿抑。
心脏和肺部病理异常在SUDEP病例中很常见，最常见的是肺水肿/充血和局灶性间质心肌纤维化。大多数发现未进行量化，存在主观因素且观察者间可靠性未明确，并且缺乏对照，如死于其他原因的匹配癫痫患者。此外，研究尚未系统评估潜在的混杂因素，包括尸检间隔时间、护理人员复苏和静脉输液、潜在的心肺疾病以及心脏或肺部疾病的危险因素。需要进行有对照的前瞻性研究来确定SUDEP中的心肺变化，并了解它们与SUDEP死亡机制的潜在关系。
