Sudden Unexpected Death in Epilepsy: Mechanisms and New Methods for Analyzing Risks builds on earlier works focusing on the clinical problem of sudden unexpected death in epilepsy (SUDEP). This book presents a methodology for identifying and classifying clusters of risks that lead to SUDEP. Developed over the last two years, the SUDEP Classification System and Risk Factor Cluster ID method will help to address gaps in our knowledge about the causes and possible prevention of this tragic complication.
Exploring the interactions among the central and peripheral autonomic nervous systems and the cardiopulmonary systems, the book includes case studies of SUDEP, definite or probable, as well as near miss cases. It discusses how neurologists, emergency room physicians, and attending physicians can identify individuals at possible risk for SUDEP and lessen the chance of occurrence. Top medical professionals in the field detail the development of an international database of human cases and animal models of SUDEP and suggest how medical examiner and coroner offices can strengthen the database by providing information about incidences of SUDEP. In addition, the book describes related clinical and animal studies needed to classify risk factors for SUDEP victims.
Understanding the risk factors and mechanisms underlying SUDEP will facilitate collaborative research in the laboratory, hospital, and clinic and lead to improved effectiveness of SUDEP prevention strategies.
Table of Contents
Forensics of SUDEP and Cluster Risk Factor Identification. Mechanistic Mystery: Risk Factors in SUDEP. SUDEP: A Syndrome with Several If Not Many Potential Underlying Mechanisms. Unravel the Global Mystery of SUDEP. Decision Analysis and Classification Methods for SUDEP Risk Factor Identification. Forensic SUDEP Cluster Risk Factor Identifier Method. Forensic Cases Classified as SUDEP Cluster Risk Factor Identifiers. How to and How Not to Use Cluster ID Method. Clinical Cases Classified as SUDEP Cluster Risk Factor Identifiers. SUDEP: Continued Forensic Challenges. A South Carolina Cohort of Epilepsy Patients. Measuring the Incidence of SUDEP Using Forensic and National Data. Risk Predictor: Individual SUDEP Risk Factor Cluster IDs. Intracranial Pressure, Cerebral Edema, and Obstructive Sleep Apnea: A Risk Factor Cluster for SUDEP? Neurocardiac Interactions in Sudden Unexpected Death in Epilepsy: Can Ambulatory Electrocardiogram-Based Assessment of Autonomic Function and T-Wave Alternans. Help to Evaluate Risk? Patient Management Using Cluster Risk Factor Identifiers. Future Clinical and Animal Studies. Animal Model Cluster IDs: Mechanisms and Risk Factors for SUDEP. SUDEP Animal Models: Mechanisms of Risks.Sudden Death Animal Models to Study Nervous System Sites of Action for Disease and Pharmacological Intervention. A Characterization of the Lockstep Phenomenon in Phenobarbital-Pretreated Cats. Relationship of the Lockstep Phenomenon and Precipitous Changes in Blood Pressure. Interspike Interval Histogram Characterization of Synchronized Cardiac Sympathetic Neural Discharge and Epileptogenic Activity in the Electrocorticogram of the Cat. SUDEP Risk Mechanisms: Animal Models and Clinical Studies. Abnormal Brain Activity Triggers Long-Term Potentiation in Sympathetic Ganglia: Implication for Sudden Death. β1-Adrenergic Blockade Prevents Cardiac Dysfunction and Increased Susceptibility to Experimental Arrhythmias Following Status Epilepticus in Rats. Cardiac Myocyte Damage, Electrocardiographic Dysfunction, and Ion Channel Remodeling in Rodent Models of Seizure Disorders. A Rat Model for Exploring the Contributions of Ventricular Arrhythmias to Sudden Death in Epilepsy. Neurotransmitters Implicated in Control of Sudden Unexpected Death in Epilepsy in Animal Models. n-3 Fatty Acids and Sudden Unexpected Death in Epilepsy: A Translational Approach. Sudden Death in Epilepsy: Relationship to the Sleep–Wake Circadian Cycle and Fractal Physiology. Lockstep in Humans: Bridging the Gap. Postictal Generalized EEG Suppression and Sudden Unexpected Death in Epilepsy. Mechanisms of SUDEP: Lessons from Cases Occurring in the Epilepsy Monitoring Unit. Compliance with Antiepileptic Drug Treatment and the Risk of SUDEP. Providing Information about SUDEP: The Benefits and Challenges. Mechanistic SUDEP Risk Factor Studies for Animals and Humans. Index.
Claire M. Lathers, PhD, FCP, has been credentialed as a senior biomedical research scientist by the FDA for international recognition of her work in the two areas of cardiovascular autonomic dysfunction associated with sudden death in persons with epilepsy and with space flight and for her professional management experience in drug development, the business world, and clinical pharmacology. The primary focus of her international cardiovascular pharmacology research career has centered on autonomic peripheral and central mechanisms involved in the control and regulation of blood pressure, heart rate and rhythm, and electroencephalogram. Dr. Lathers served as President Clinton’s lead person on the Food Safety Program at FDA, was Director of the Office of New Animal Drug Evaluation and a Senior Advisor for Science at FDA.
Paul L. Schraeder, MD, FAAN, is Professor Emeritus of Neurology at Drexel University College of Medicine. Along with Dr. Lathers, Dr. Schraeder has spent over three decades studying and investigating the mystery of SUDEP and developed the first experimental animal models of this fatal phenomenon. Dr. Schraeder organized a collaborative nationwide survey of how coroners and medical examiners evaluate the deaths of persons with a history of epilepsy.
Jan E. Leestma, MD, MBA, is licensed as a physician in the states of Illinois and Michigan and certified by the American Board of Pathology in both Anatomic Pathology and Neuropathology. His areas of expertise and publication history include sudden unexpected death in epilepsy, viral infections of the central nervous system, and forensic neuropathology.
Braxton B. Wannamaker, MD, FAAN is Clinical Professor of Neurology at the Medical University of South Carolina (MUSC). In his long career devoted to comprehensive care of persons with epilepsy, Dr. Wannamaker has served as a member of the NINDS Epilepsy Advisory Committee, as a board member of the Epilepsy Foundation of America, and as president of the American Epilepsy Society.
Richard L. Verrier, PhD, FACC, is Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts. He has investigated autonomic factors in sudden cardiac death for over 25 years in both clinical and experimental studies. He demonstrated that the phenomenon of T-wave alternans (TWA) is strongly correlated with ventricular fibrillation, the arrhythmia responsible for sudden cardiac death in patients with cardiovascular disease.
Steven C. Schachter, MD, is Professor of Neurology at Harvard Medical School; chief academic officer and director of neurotechnology for the Consortia for Improving Medicine Through Innovation and Technology in Boston, Massachusetts; and senior neurologist at Beth Israel Deaconess Medical Center, Boston. He has directed over 70 research projects involving antiepileptic therapies and published over 200 articles and chapters. He compiled the six-volume Brainstorms series, and edited or wrote 23 other books on epilepsy and behavior.