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From unwitnessed fatality to witnessed rescue: Nonpharmacologic interventions in sudden unexpected death in epilepsy
Author(s) -
RuggGunn Fergus,
Duncan John,
Hjalgrim Helle,
Seyal Masud,
Bateman Lisa
Publication year - 2016
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13231
Subject(s) - medicine , epilepsy , cardiorespiratory fitness , psychological intervention , electroencephalography , intensive care medicine , sudden death , coma (optics) , intervention (counseling) , anesthesia , physical therapy , cardiology , psychiatry , physics , optics
Summary Sudden unexpected death in epilepsy ( SUDEP ) risk reduction remains a critical aim in epilepsy care. To date, only aggressive medical and surgical efforts to control seizures have been demonstrated to be of benefit. Incomplete understanding of SUDEP mechanisms limits the development of more specific interventions. Periictal cardiorespiratory dysfunction is implicated in SUDEP ; postictal electroencephalography ( EEG ) suppression, coma, and immobility may also play a role. Nocturnal supervision is protective against SUDEP , presumably by permitting intervention in the case of a life‐threatening event. Resuscitative efforts were implemented promptly in near‐ SUDEP cases but delayed in SUDEP deaths in the Mortality in Epilepsy Monitoring Unit Study (MORTEMUS) study. Nursing interventions—including repositioning, oral suctioning, and oxygen administration—reduce seizure duration, respiratory dysfunction, and EEG suppression in the epilepsy monitoring unit ( EMU ), but have not been studied in outpatients. Cardiac pacemakers or cardioverter‐defibrillator devices may be of benefit in a few select individuals. A role for implantable neurostimulators has not yet been established. Seizure detection devices, including those that monitor generalized tonic–clonic seizure‐associated movements or cardiorespiratory parameters, may provide a means to permit timely periictal intervention. However, these and other devices, such as antisuffocation pillows, have not been adequately investigated with respect to SUDEP prevention.