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Herzschrittmachertherapie + Elektrophysiologie

, Volume 30, Issue 3, pp 274–286 | Cite as

Plötzlicher unerwarteter Tod bei Epilepsie (SUDEP)

Epidemiologie, kardiale und andere Risikofaktoren
  • Theodor W. MayEmail author
  • Carsten W. Israel
Schwerpunkt
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Zusammenfassung

Der plötzliche unerwartete Tod bei Epilepsie („sudden unexpected death in epilepsy“, SUDEP) ist eine der häufigsten epilepsiebedingten Todesursachen. Die SUDEP-Inzidenz wird auf etwa 1,2/1000 Personenjahre (PJ) geschätzt mit erheblicher Variation in Abhängigkeit von krankheitsspezifischen und demographischen Faktoren. Die geschätzte SUDEP-Inzidenz bei Kindern ist mit etwa 0,22/1000 PJ deutlich niedriger als bei Erwachsenen, jedoch weisen neuere Studien bei Kindern (>12 Jahre) auf eine ähnlich hohe SUDEP-Inzidenz wie bei Erwachsenen hin. Bei o. g. geschätzter Inzidenz wären in Deutschland rund 700 SUDEP-Fälle pro Jahr zu erwarten, wobei keine zuverlässigen Daten hierzu vorliegen. Eine Reihe von Risikofaktoren bzw. Prädiktoren für SUDEP ist untersucht worden, z. B. Alter, Anfallshäufigkeit, Anzahl der Antiepileptika, Non-Compliance, Komorbidität, mit zum Teil widersprüchlichen Ergebnissen. Dies ist insofern verständlich als die exakte Pathogenese des SUDEP unklar ist. Sehr wahrscheinlich ist jedoch, dass die Häufigkeit (nächtlicher) generalisierter tonisch-klonischer Anfälle den wichtigsten Risikofaktor darstellt. Ein Faktor, der wahrscheinlich das SUDEP-Risiko senkt, ist eine nächtliche Überwachung von Anfällen (mittels Geräten) oder die nächtliche Anwesenheit einer anderen Person. Anfallskontrolle und Anfallsüberwachung sind nach gegenwärtigem Kenntnisstand die wichtigsten Faktoren, um einen SUDEP zu vermeiden. In den letzten Jahren haben einige Studien dazu beigetragen, mögliche Pathomechanismen des SUDEP besser zu verstehen. Weiterhin besteht ein erheblicher Forschungsbedarf, nicht nur zur Erkennung klinischer Prädiktoren und Biomarker, sondern auch bezüglich der Prävention.

Schlüsselwörter

Tonisch-klonischer Anfall Plötzlicher Herztod Risikofaktoren Antiepileptika Mortalität 

Sudden unexpected death in epilepsy (SUDEP)

Epidemiology, cardiac and other risk factors

Abstract

Sudden unexpected death in epilepsy (SUDEP) is one of the most frequent epilepsy-related causes of death. The incidence of SUDEP is estimated to be approximately 1.2/1000 person-years (PY); however, it varies considerably depending on disease-specific and demographic factors. The estimated incidence of SUDEP in children seems to be significantly lower (0.22/1000 PY) than in adults but recent studies in children (>12 years) indicated a similar incidence to that of adults. Based on these estimations, approximately 700 SUDEP cases would be expected in Germany annually but no reliable data or epidemiological studies on SUDEP are available. Various risk factors and predictors for SUDEP have been investigated, e.g. age, seizure frequency, number of antiepileptic drugs, non-compliance and comorbidities, with sometimes contradictory results. This is understandable given that the exact mechanisms of SUDEP are unclear; however, it is very likely that the frequency of (nocturnal) generalized tonic-clonic seizures is the most important risk factor. Nocturnal monitoring of seizures (using devices) or the presence of another person at night may represent important factors to reduce the risk of SUDEP. Thus, seizure control and seizure monitoring are, according to current knowledge, the most important factors to avoid SUDEP. Some recent studies have contributed to a better understanding of possible pathomechanisms of SUDEP; however, further research is needed to identify predictive clinical factors and biomarkers and in particular to prevent SUDEP.

Keywords

Tonic-clonic seizures Sudden cardiac death Risk factors Antiepilepticdrugs Mortality 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T.W. May und C.W. Israel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Koordinierungsstelle für klinische Studien in der Biomedizin und präklinische und klinische ForschungEv. Klinikum BethelBielefeldDeutschland
  2. 2.Klinik für Innere Medizin – Kardiologie, Diabetologie und NephrologieEv. Klinikum BethelBielefeldDeutschland

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