Seo Myung Ha, Sung Won Young
Department of Emergency Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea.
Open Access Emerg Med. 2019 Jul 19;11:161-166. doi: 10.2147/OAEM.S214619. eCollection 2019.
Sudden unexpected death in epilepsy (SUDEP) refers to the sudden and unexpected death of an epileptic patient with no other health issues, during normal activity, and for whom no other particular cause of death can be found. The exact cause of SUDEP has not been established yet; however, it is assumed to be caused by multiple organ failure involving the respiratory and cardiovascular systems. Some of the known risk factors are generalized tonic-clonic seizure, frequent epileptic seizure, early onset of epilepsy, long duration of seizure, nocturnal seizure, and combined therapy with antiepileptics. A number of seizure-related cardiac arrhythmia cases have been reported. Arrhythmias are mostly benign tachycardia or bradycardia, and ventricular fibrillation (VF) or asystole is very rare. It is considered that fatal cardiac arrhythmia is a cause of SUDEP. Here, we describe the case of a near-SUDEP patient who was successfully revived without complications by immediate defibrillation with an automated external defibrillator and cardiopulmonary resuscitation, although VF occurred after a convulsive seizure. Based on our experience, when treating a patient with an epileptic seizure, one should always keep in mind the possibility of SUDEP as a seizure-induced emergency situation involving fatal arrhythmia and cardiac arrest, even in young healthy adults.
癫痫猝死（SUDEP）是指癫痫患者在无其他健康问题的情况下，于正常活动期间突然意外死亡，且找不到其他特定死因。SUDEP的确切病因尚未明确；不过，推测其由涉及呼吸和心血管系统的多器官功能衰竭所致。一些已知的风险因素包括全身强直阵挛发作、频繁癫痫发作、癫痫早发、发作持续时间长、夜间发作以及抗癫痫药物联合治疗。已报告了一些与发作相关的心律失常病例。心律失常大多为良性心动过速或心动过缓，室颤（VF）或心搏停止非常罕见。致命性心律失常被认为是SUDEP的一个病因。在此，我们描述了一例接近SUDEP的患者，尽管在惊厥发作后出现了VF，但通过自动体外除颤器立即除颤和心肺复苏成功复苏且无并发症。根据我们的经验，在治疗癫痫发作患者时，即使是年轻健康的成年人，也应始终牢记SUDEP作为一种由发作引发的紧急情况，可能涉及致命性心律失常和心脏骤停的可能性。
