Sudden unexplained death in grand mal seizures / epilepsy (SUDEP) is a rare condition that strikes patients with seizure disorders. It occurs in 1 in 1000 persons over 1 year but the risk is largely elevated to 1 in 100 over 1 year for persons with uncontrolled generalized tonic-clonic seizures. Moreover, higher frequency of generalized convulsive seizures is often linked to a higher risk for SUDEP.
Risk Factors for Sudden Unexplained Death In Epilepsy
The frequent occurrence of grand mal seizures predisposes patients with seizure disorders to SUDEP. In fact, a study showed that patients who had 1 to 3 grand mal seizure episodes in a year had 2.5 times greater susceptibility to SUDEP than those who never had seizure episodes. An observation also indicated that 90% to 100% of patients who had SUDEP also had a history of grand mal / tonic clonic seizures and, according to findings, SUDEP usually occurs during or after the onset of the seizures. Other risk factors associated with SUDEP are the following:
- Uncontrolled or poorly controlled grand mal seizures
- Long seizure durations
- Early onset of seizure disorders
- Frequent adjustments in anti-seizure medications
- Polytherapy
Possible Cause Of Sudden Unexplained Death In Epilepsy
The root cause of SUDEP and the mechanism by which it occurs is still unknown. It is also unclear as to what causes one episode of grand mal seizures to be fatal when all the other seizure episodes the patients had were not. In an attempt to explain SUDEP, several hypotheses were formulated by researchers. One of these suspects the peri-ictal cardio-respiratory dysfunction to be the main culprit that causes SUDEP. In addition, the association of autonomic dysfunctions and genetic mutations to the occurrence of SUDEP is still being determined. Studies on animal models indicate that SUDEP may be caused by insufficient serotonergic activities which raises the possibility of using selective serotonin reuptake inhibitors (SSRI) for the prevention of SUDEP. Since cardiac factors are associated with SUDEP, a study suggests that the abnormal cardiac rhythms may be caused by irregularities in the mechanisms within the voltage-gated ion channels in the cardiac muscles.
Measures That Can Prevent Sudden Unexplained Death In Grand Mal Seizures
Supervision seems to have a very important role in the prevention of SUDEP, according to an observation which shows that nighttime supervision of patients with seizure disorders decreases SUDEP risk by 60%. This supervision can be done by allowing a person who is at least 10 years old and with normal intelligence, to stay in the same room with the patient. This preventive measure, however, requires more concrete evidence for it to be prescribed. As of the moment, the focus of SUDEP prevention is on the education and counseling of both the patients and their families about the condition and risk factors associated with it. Also, patients who are suffering from grand mal seizures are strongly advised to communicate with their doctors and seek for the best seizure control possible. Should the seizures remain intractable, the patients have the choice of taking advanced treatments such as surgery.
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