癫痫患者的突发性意外死亡。
Sudden unexpected death in epilepsy.
机构信息
NYU Grossman School of Medicine, Department of Neurology, 223 East 34th Street, New York, New York, USA.
出版信息
Curr Opin Neurol. 2022 Apr 1;35(2):181-188. doi: 10.1097/WCO.0000000000001034.
PURPOSE OF REVIEW
Sudden unexpected death in epilepsy (SUDEP) is a major contributor to premature mortality in people with epilepsy. This review provides an update on recent findings on the epidemiology of SUDEP, clinical risk factors and potential mechanisms.
RECENT FINDINGS
The overall risk rate of SUDEP is approximately 1 per 1000 patients per year in the general epilepsy population and that children and older adults have a similar incidence. Generalized convulsive seizures (GCS), perhaps through their effects on brainstem cardiopulmonary networks, can cause significant postictal respiratory and autonomic dysfunction though other mechanisms likely exist as well. Work in animal models of SUDEP has identified multiple neurotransmitter systems, which may be future targets for pharmacological intervention. There are also chronic functional and structural changes in autonomic function in patients who subsequently die from SUDEP suggesting that some SUDEP risk is dynamic. Modifiable risks for SUDEP include GCS seizure frequency, medication adherence and nighttime supervision.
SUMMARY
Current knowledge of SUDEP risk factors has identified multiple targets for SUDEP prevention today as we await more specific therapeutic targets that are emerging from translational research studies.
目的综述
癫痫性猝死（SUDEP）是导致癫痫患者过早死亡的主要原因。本综述提供了关于 SUDEP 的流行病学、临床危险因素和潜在机制的最新发现。
最近的发现
在一般癫痫人群中，SUDEP 的总体风险率约为每 1000 名患者每年 1 例，儿童和老年人的发病率相似。全身性强直-阵挛发作（GCS），可能通过其对脑干心肺网络的影响，导致明显的癫痫后呼吸和自主神经功能障碍，但也可能存在其他机制。SUDEP 动物模型的研究已经确定了多个神经递质系统，这些系统可能是未来药物干预的靶点。在随后死于 SUDEP 的患者中，自主神经功能也存在慢性功能和结构变化，这表明一些 SUDEP 风险是动态的。SUDEP 的可改变危险因素包括 GCS 发作频率、药物依从性和夜间监护。
总结
目前对 SUDEP 危险因素的认识已经确定了多个 SUDEP 预防的目标，我们正在等待从转化研究中出现的更具体的治疗靶点。
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