Proposed Mechanism-Based Risk Stratification and Algorithm to Prevent Sudden Death in Epilepsy

Frontiers in Neurology

Richard Kollmar¹  Michael Lucchesi²  Joshua B. Silverman⁴  Krishnamurthi Sundaram⁵  Mark Stewart⁶ 

[1] Department of Cell Biology, State University of New York Health Sciences University, Brooklyn, NY, United States;Department of Emergency Medicine, State University of New York Health Sciences University, Brooklyn, NY, United States;Department of Neurology, State University of New York Health Sciences University, Brooklyn, NY, United States;Department of Otolaryngology, North Shore Long Island Jewish Medical Center, New Hyde Park, NY, United States;Department of Otolaryngology, State University of New York Health Sciences University, Brooklyn, NY, United States;;Department of Physiology &

关键词: apnea;    laryngospasm;    SUDEP;    airway obstruction;    respiratory arrest;   

DOI  :  10.3389/fneur.2020.618859

来源: DOAJ

【 摘 要 】

Sudden Unexpected Death in Epilepsy (SUDEP) is the leading cause of death in young adults with uncontrolled seizures. First aid guidance to prevent SUDEP, though, has not been previously published because the rarity of monitored cases has made the underlying mechanism difficult to define. This starkly contrasts with the first aid guidelines for sudden cardiac arrest that have been developed based on retrospective studies and expert consensus and the discussion of resuscitation challenges in various American Heart Association certificate courses. However, an increasing amount of evidence from documented SUDEP cases and near misses and from animal models points to a consistent sequence of events that starts with sudden airway occlusion and suggests a mechanistic basis for enhancing seizure first aid. In monitored cases, this sudden airway occlusion associated with seizure activity can be accurately inferred from inductance plethysmography or (depending on recording bandwidth) from electromyographic (EMG) bursts that are associated with inspiratory attempts appearing on the electroencephalogram (EEG) or the electrocardiogram (ECG). In an emergency setting or outside a hospital, seizure first aid can be improved by (1) keeping a lookout for sudden changes in airway status during a seizure, (2) distinguishing thoracic and abdominal movements during attempts to inspire from effective breathing, (3) applying a simple maneuver, the laryngospasm notch maneuver, that may help with airway management when aggressive airway management is unavailable, (4) providing oxygen early as a preventative step to reduce the risk of death, and (5) performing cardiopulmonary resuscitation before the limited post-ictal window of opportunity closes. We propose that these additions to first aid protocols can limit progression of any potential SUDEP case and prevent death. Risk stratification can be improved by recognition of airway occlusion, attendant hypoxia, and need for resuscitation.

【 授权许可】

Unknown