David M. Ficker

Population-based study of the incidence of sudden unexplained death in epilepsy

Objective: To determine the population-based incidence of sudden unexplained death in epilepsy (SUDEP) and to determine the risk of SUDEP compared with the general population. Background: Prior studies of SUDEP have described a wide range of incidence and have suffered from selection bias and other methodologic limitations. A population-based study of the incidence of SUDEP has never been performed. Furthermore, the risk of sudden death in the epilepsy population has not been compared with that of the general population. Methods: All deaths in persons whose epilepsy was diagnosed between 1935 and 1994 in Rochester, MN, were reviewed. The rate of SUDEP was compared with the expected rate of sudden death in the general population for patients age 20 to 40 years to determine the standardized mortality ratio (SMR). Results: We identified nine cases of SUDEP. SUDEP accounted for 8.6% (7 of 81) of the deaths in persons 15 to 44 years of age. The incidence of SUDEP was 0.35 per 1,000 person-years. SMR for SUDEP was 23.7 (95% confidence interval, 7.7 to 55.0) compared with the general population. Conclusions: The incidence of SUDEP in our study was 0.35 per 1,000 person-years. SUDEP was responsible for 1.7% of deaths in our cohort. SUDEP is a rare cause of death in the epilepsy population but exceeds the expected rate of sudden death in the general population by nearly 24 times.

Four-year incidence of psychogenic nonepileptic seizures in adults in Hamilton County, OH

Article abstract In this retrospective study, the incidence of psychogenic nonepileptic seizures in Hamilton County, OH, between 1995 and 1998 was determined. The mean incidence of psychogenic nonepileptic seizures was 3.03/100,000, with the highest incidence in 1998 (4.6/100,000). Most patients with the diagnosis of psychogenic nonepileptic seizures were aged 25 to 45 years (4.38/100,000).–1563

Sudden Unexplained Death and Injury in Epilepsy

Summary: Seizures may be associated with risk of injury or death. Injuries are common in patients with epilepsy, with up to 30% of patients reporting injuries, most commonly blunt trauma and lacerations. Seizures associated with falls increase the risk of injury, but any seizure that is associated with alteration in consciousness may cause injury. Patients with seizures may injure others, especially by causing motor vehicle accidents. Each state has restrictions on driving, requiring seizure‐free intervals that range from 3 to 18 months. Mortality is increased in patients with epilepsy. The standardized mortality ratio is increased two to three times in epilepsy cohorts. Sudden unexplained death in epilepsy (SUDEP) is responsible for 2% to 17% of all deaths in patients with epilepsy, depending on the cohort studied. Population‐based studies of SUDEP show a lower overall SUDEP rate compared with clinical trials or epilepsy referral center cohorts. Overall, the risk of sudden death is increased in the epilepsy population by 24 times compared with the general population. Risk factors for SUDEP may include poorly controlled seizures, early onset of epilepsy, and generalized tonic‐clonic seizures. The pathophysiology of SUDEP is unknown, but animal data suggest apnea may be the initial factor that results in sudden death.

Quality of Life in Psychogenic Nonepileptic Seizures

Summary:  Purpose: Psychogenic nonepileptic seizures (PNESs) are events that alter or seem to alter the neurologic function and, in their appearance, resemble epileptic seizures (ESs). In patients with ESs the psychological and medical aspects of epilepsy greatly influence the health‐related quality of life (HRQOL). The relation between these factors and PNESs is not well established. In this study, we compared HRQOL in patients with PNESs with that of patients with ESs.

Occurrence of seizure clusters and status epilepticus during inpatient video-EEG monitoring

Objective: To investigate the occurrence of status epilepticus and seizure clusters, and the duration until first seizure at epilepsy monitoring units in the United States. Methods: The authors examined the inpatient video-EEG monitoring reports of 514 consecutive patients admitted to five comprehensive epilepsy centers during the year 2000. Time to first seizure, seizure clustering, and seizure duration were ascertained from reports and entered into a database. Results: In 169 admissions with complex partial seizures (CPSs) or secondarily generalized tonic-clonic (2GTC) seizures, there were 5 (3.0%) patients with status epilepticus, 30 (17.8%) with 4-hour seizure clusters, and 82 (48.5%) with 24-hour seizure clusters. There were no statistically significant differences between centers, except that seizure clusters were observed to be less common at the one center with a formal drug withdrawal protocol. The average time to CPS or 2GTC seizure was 2.1 days; the average number of days to nonepileptic event was 1.2 days (p = 0.001). Conclusions: Although status epilepticus is uncommon at epilepsy monitoring units, clusters of seizures are common. Intensive monitoring with drug withdrawal must be performed in a highly supervised, hospitalized setting. Inpatient video-EEG monitoring is efficient, with recording of the first epileptic or nonepileptic events in 2 days or less.

Improvement and Deterioration of Seizure Control During the Postsurgical Course of Epilepsy Surgery Patients

Summary: Purpose: To determine the factors associated with changes in seizure control during the postsurgical course of epilepsy surgery patients.

Valproic acid blood genomic expression patterns in children with epilepsy - a pilot study.

Objective – Valproic acid (VPA) is a commonly used anticonvulsant with multiple systemic effects. The purpose of this pilot study is to examine the blood genomic expression pattern associated with VPA therapy in general and secondly VPA efficacy in children with epilepsy.

Improved tolerability and efficacy in epilepsy patients with extended-release carbamazepine

The authors conducted a 3-month, prospective, open-label study assessing the effects of switching from immediate-release carbamazepine formulations to an equal total daily dose of carbamazepine extended-release capsules (CBZ-ERC) in adolescents and adults with epilepsy. Using validated, epilepsy-specific measures the authors found that switching to CBZ-ERC significantly improved patients’ adverse events and quality-of-life measures. Switching to CBZ-ERC also improved seizure control.

Spreading depression in continuous electroencephalography of brain trauma

Cortical spreading depolarizations are a pathophysiological mechanism and candidate target for advanced monitoring in acute brain injury. Here we investigated manifestations of spreading depolarization in continuous electroencephalography (EEG) as a broadly applicable, noninvasive method for neuromonitoring.

Epileptiform abnormalities in hepatic encephalopathy.

Epileptiform abnormalities are uncommon in patients with hepatic encephalopathy. A review of EEGs in patients with hepatic encephalopathy over a 10-year period identified 18 (15%) with epileptiform abnormalities. Thirteen patients had interictal discharges consisting of focal spike and sharp wave discharges, bilateral independent discharges, and generalized spike and wave discharges. A total of 10 patients had electrographic seizure discharges, focal in 6 and generalized in 5 (some patients had more than one abnormality). Twelve patients had clinical seizures, partial in four and generalized in eight. Neuroimaging failed to provide an etiology for the generation of epileptiform discharges in most patients, including those with focal abnormalities. Most patients with epileptiform discharges died or deteriorated. We conclude that epileptiform can be seen in patients with hepatic encephalopathy, and when present imply a poor prognosis.