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Seizure Mar 2023Sudden Unexpected Death in Epilepsy (SUDEP) is a major concern for people with epilepsy, their families, their care givers, and medical professionals. There is... (Review)
Review
Sudden Unexpected Death in Epilepsy (SUDEP) is a major concern for people with epilepsy, their families, their care givers, and medical professionals. There is inconsistency in the SUDEP counselling doctors provide, compared to what is recommended in clinical guidelines. Numerous national and international surveys have highlighted how epilepsy professionals, usually doctors, deliver SUDEP risk counselling, particularly, when they deliver it and to whom. These surveys help understand the unmet need, develop suitable strategies, and raise awareness among clinicians with the eventual goal to reduce SUDEPs. However, there is no standardised survey or essential set of questions identified that can be used to evaluate SUDEP counselling practice globally. This focused review analyses the content of all published SUDEP counselling surveys for medical professionals (n=16) to date covering over 4000 doctors across over 30 countries and five continents. It identifies 36 question themes across three topics. The questions are then reviewed by an expert focus group of SUDEP communication experts including three doctors, an expert statistician and SUDEP Action, an UK based charity specialising in epilepsy deaths with a pre-set criterion. The review and focus group provide ten essential questions that should be included in all future surveys inquiring on SUDEP counselling. They could be used to evaluate current practice and compare findings over time, between services, across countries and between professional groups. They are provided as a template to download and use. The review also explores if there is a continued need in future for similar surveys to justify this activity.
Topics: Humans; Sudden Unexpected Death in Epilepsy; Risk Factors; Epilepsy; Death, Sudden; Physicians
PubMed: 36706666
DOI: 10.1016/j.seizure.2023.01.007 -
FEMS Immunology and Medical Microbiology Aug 1999Sudden infant death syndrome (SIDS) is sudden unexpected death in infancy for which there is no explanation based on commonly accepted diagnostic criteria; however, half... (Review)
Review
Sudden infant death syndrome (SIDS) is sudden unexpected death in infancy for which there is no explanation based on commonly accepted diagnostic criteria; however, half of the victims have had slight signs of infection prior to death. Such slight infection with fever is an important risk factor in combination with a prone sleeping position, especially in infants between 2 and 4 months of age. The purpose of this review is to summarise findings that support the theory that a significant part of cot deaths may be due to an overreaction to otherwise harmless infections. Such factors are mucosal immune stimulation, cytokines in the cerebrospinal fluid and hypoxanthine levels in vitreous humour. The review aims at explaining why we believe that a slight infection combined with a prone position, a warm environment and a vulnerable age period may trigger a vicious circle leading to death.
Topics: Cytokines; Humans; Infant; Infant, Newborn; Inflammation; Prone Position; Respiratory Tract Infections; Risk Factors; Sleep; Sudden Infant Death
PubMed: 10443493
DOI: 10.1111/j.1574-695X.1999.tb01328.x -
FEMS Immunology and Medical Microbiology Sep 2004Epidemiological studies found the incidence of SIDS among Indigenous groups such as Aboriginal Australians, New Zealand Maoris and Native Americans were significantly... (Review)
Review
Epidemiological studies found the incidence of SIDS among Indigenous groups such as Aboriginal Australians, New Zealand Maoris and Native Americans were significantly higher than those for non-Indigenous groups within the same countries. Among other groups such as Asian families in Britain, the incidence of SIDS has been lower than among groups of European origin. Cultural and childrearing practices as well as socio-economic factors have been proposed to explain the greater risk of SIDS among Indigenous peoples; however, there are no definitive data to account for the differences observed. We addressed the differences among ethnic groups in relation to susceptibility to infection because there is evidence from studies of populations of European origin that infectious agents, particularly toxigenic bacteria might trigger the events leading to SIDS. The risk factors for SIDS parallel those for susceptibility to infections in infants, particularly respiratory tract infections which are also major health problems among Indigenous groups. Many of the risk factors identified in epidemiological studies of SIDS could affect three stages in the infectious process: (1) frequency or density of colonisation by the toxigenic species implicated in SIDS; (2) induction of temperature-sensitive toxins; (3) modulation of the inflammatory responses to infection or toxins. In this review we compare genetic, developmental and environmental risk factors for SIDS in ethnic groups with different incidences of SIDS: low (Asians in Britain); moderate (European/Caucasian); high (Aboriginal Australian). Our findings indicate: (1) the major difference was high levels of exposure to cigarette smoke among infants in the high risk groups; (2) cigarette smoke significantly reduced the anti-inflammatory cytokine interleukin-10 responses which control pro-inflammatory responses implicated in SIDS; (3) the most significant effect of cigarette smoke on reduction of IL-10 responses was observed for donors with a single nucleotide polymorphism for the IL-10 gene that is predominant among both Asian and Aboriginal populations. If genetic makeup were a major factor for susceptibility to SIDS, the incidence of these deaths should be similar for both populations. They are, however, significantly different and most likely reflect differences in maternal smoking which could affect frequency and density of colonisation of infants by potentially pathogenic bacteria and induction and control of inflammatory responses.
Topics: Humans; Infant; Infections; Racial Groups; Risk Factors; Sudden Infant Death
PubMed: 15325398
DOI: 10.1016/j.femsim.2004.06.007 -
Vaccine Mar 1994Despite extensive research, no unifying concept has satisfactorily explained the cause of the sudden infant death syndrome (SIDS). The details are briefly outlined of... (Review)
Review
Despite extensive research, no unifying concept has satisfactorily explained the cause of the sudden infant death syndrome (SIDS). The details are briefly outlined of some of the evidence supporting the hypothesis that common bacterial toxins are important in the aetiology of SIDS. These bacterial toxins act as triggers to initiate a biochemical cascade resulting in death. Data from four research groups, each working independently, indicated that the bacteria Clostridium perfringens, Escherichia coli, Staphylococcus aureus, Streptococcus spp. and Enterococcus spp. were present in higher numbers in infants who had suffered SIDS than in control infants. Certainly more detailed studies need to be performed on the role of bacterial infections in infants. There are many implications arising from this work, particularly the use of vaccination as a means of reducing infections, and consequently the number of SIDS deaths.
Topics: Bacterial Toxins; Bacterial Vaccines; Humans; Infant; Sudden Infant Death
PubMed: 8178560
DOI: 10.1016/0264-410x(94)90102-3 -
Legal Medicine (Tokyo, Japan) Mar 2011The essential tasks of forensic pathology involve investigation of the cause and process of death, especially in traumatic and unexpected sudden deaths, largely... (Review)
Review
The essential tasks of forensic pathology involve investigation of the cause and process of death, especially in traumatic and unexpected sudden deaths, largely including unwitnessed deaths. Thus, agonal and postmortem interference is inevitable and unpredictable in all forensic procedures; this is not particular to forensic biochemistry, but also occurs in morphology and toxicology. Therefore, findings should be assessed based on the postmortem data established through serial investigations of autopsy materials using easily accessible standardized procedures. With respect to this, biochemical procedures have advantages of standardization, quality assurance, quantitative analyses, statistic assessment and availability of multiple markers, despite several problems involved in the selection and collection of materials and applicability of analytical procedures. The main purpose of using postmortem biochemistry as well as molecular biology is to investigate the systemic pathophysiological changes involved in the death process that cannot usually be detected by morphological methods; these may be called 'pathophysiological vital reactions'. These procedures can provide useful support for pathological evidence by 'visualization' of functional alterations, and are also essential for the pathognomonic assessment of both the cause and process of death as part of routine laboratory investigations involved in 'full autopsy' in the context of social risk management.
Topics: Autopsy; Biochemistry; Biomarkers; Death, Sudden; Forensic Pathology; Humans; Molecular Biology; Postmortem Changes
PubMed: 21269863
DOI: 10.1016/j.legalmed.2010.12.005 -
Journal of Neuropathology and... Mar 2020Sudden unexplained death in childhood (SUDC) affects children >1-year-old whose cause of death remains unexplained following comprehensive case investigation and is...
Sudden unexplained death in childhood (SUDC) affects children >1-year-old whose cause of death remains unexplained following comprehensive case investigation and is often associated with hippocampal abnormalities. We prospectively performed systematic neuropathologic investigation in 20 SUDC cases, including (i) autopsy data and comprehensive ancillary testing, including molecular studies, (ii) ex vivo 3T MRI and extensive histologic brain samples, and (iii) blinded neuropathology review by 2 board-certified neuropathologists. There were 12 girls and 8 boys; median age at death was 33.3 months. Twelve had a history of febrile seizures, 85% died during apparent sleep and 80% in prone position. Molecular testing possibly explained 3 deaths and identified genetic mutations in TNNI3, RYR2, and multiple chromosomal aberrations. Hippocampal abnormalities most often affected the dentate gyrus (altered thickness, irregular configuration, and focal lack of granule cells), and had highest concordance between reviewers. Findings were identified with similar frequencies in cases with and without molecular findings. Number of seizures did not correlate with hippocampal findings. Hippocampal alterations were the most common finding on histological review but were also found in possibly explained deaths. The significance and specificity of hippocampal findings is unclear as they may result from seizures, contribute to seizure pathogenesis, or be an unrelated phenomenon.
Topics: Brain; Child; Child, Preschool; Death, Sudden; Female; Hippocampus; Humans; Infant; Male; Sudden Infant Death
PubMed: 31995186
DOI: 10.1093/jnen/nlz136 -
West African Journal of Medicine 2003Sudden death of an infant is not an uncommon event and when there is no adequate cause to explain the death it poses a diagnostic dilemma for the clinician, and makes... (Review)
Review
Sudden death of an infant is not an uncommon event and when there is no adequate cause to explain the death it poses a diagnostic dilemma for the clinician, and makes discussion of the cause of death with parents quite difficult and unsatisfactory. Sudden infant death syndrome (SIDS) or cot death is a diagnostic entity which can be applied in such a case. It is one of the most common causes of infant deaths world-wide in the postneonatal period, from 1 month to 1 year of age. Features which may assist the clinician to arrive at such a diagnosis are discussed in this paper. Since the first sign of SIDS is death, leaving the clinician with no opportunity to intervene, attention has been focussed on whether or not the infants prone to suffer from this tragic demise can be identified and preventive measures instituted to save them. In this respect, intensive and extensive research efforts over the last two decades have led to what is now commonly referred to as the Apnea Hypothesis for SIDS, and the resultant current intervention method of home apnea monitoring. The apnea hypothesis and other aetiological factors that may help predict infants at risk are discussed. Finally, current management of infants at risk is discussed for completeness since the facilities for such management are not yet in common use in Nigeria and the West African sub-region, and the level of literacy may severely limit the size of the population that could benefit from such management even if the facilities were available.
Topics: Humans; Infant; Polysomnography; Sleep Apnea Syndromes; Sudden Infant Death
PubMed: 12769316
DOI: 10.4314/wajm.v22i1.27988 -
Epilepsia Oct 2021Persons with epilepsy have an increased mortality including a high risk of sudden unexplained death (SUD), also referred to as sudden unexpected death in epilepsy...
OBJECTIVE
Persons with epilepsy have an increased mortality including a high risk of sudden unexplained death (SUD), also referred to as sudden unexpected death in epilepsy (SUDEP). We aimed to evaluate the risk of SUDEP in comparison to other causes of death and the risk of SUD in persons with and without epilepsy.
METHODS
We undertook a retrospective population-based cohort study of all Danish citizens with and without epilepsy aged 1-49 years during 2007-2009. All deaths in the population were evaluated, and all cases of SUD identified. Primary causes of death in persons with epilepsy were evaluated independently by three neurologists and one neuropediatrician, using the unified SUDEP criteria.
RESULTS
The three most frequent causes of death in persons with epilepsy were cancer (2.38 per 1000 person-years), SUDEP (1.65 per 1000 person-years), and pneumonia (1.09 per 1000 person-years) compared with cancer (.17 per 1000 person-years), accident-related deaths (.14 per 1000 person-years), and cardiovascular disease (.09 per 1000 person-years) in persons without epilepsy. Considering definite, definite plus, and probable cases, the SUDEP incidence was .27 per 1000 person-years (95% confidence interval [CI] = .11-.64) in children aged 1-17 years and 1.21 per 1000 person-years (95% CI = .96-1.51) in adults aged 18-49 years. Adjusted for age and sex, persons with epilepsy younger than 50 years had a 10.8-fold (95% CI = 9.97-11.64, p < .0001) increased all-cause mortality and a 34.4-fold (95% CI = 23.57-50.28, p < .0001) increased risk of SUD compared with persons without epilepsy. SUDEP accounted for 23.3% of all SUD.
SIGNIFICANCE
This nationwide study of all deaths in persons with epilepsy younger than 50 years found a lower SUDEP risk in children compared with adults, and that epilepsy was a major risk factor for SUD in the background population. This underlines the importance of addressing risk factors for SUDEP to prevent premature death.
Topics: Adult; Child; Cohort Studies; Death, Sudden; Denmark; Epilepsy; Humans; Retrospective Studies; Risk Factors; Sudden Unexpected Death in Epilepsy
PubMed: 34418071
DOI: 10.1111/epi.17037 -
Acta Paediatrica (Oslo, Norway : 1992) Jan 2021This study aimed to systematically analyse the pregnancy, birth and demographic-related factors associated with age of death in sudden unexpected infant death (SUID).
AIM
This study aimed to systematically analyse the pregnancy, birth and demographic-related factors associated with age of death in sudden unexpected infant death (SUID).
METHODS
Data were analysed from the Centers for Disease Control and Prevention's Cohort Linked Birth/Infant Death data set (2011-2013; 11 737 930 live births). SUID was defined as deaths from sudden infant death syndrome, ill-defined causes, or accidental suffocation and strangulation in bed. There were 9668 SUID cases (7-364 days; gestation >28 weeks; 0.82/1000 live births). The odds of death at different ages were compared to determine which variables significantly affect the SUID age of death.
RESULTS
Forty-three features indicated a significant change in age of death with two main patterns: (a) younger chronologic age at death was associated with maternal smoking and factors associated with lower socio-economic status, and (b) older age was associated with low birthweight, prematurity and admission to the neonatal intensive care unit. However, when age was corrected for gestation, these factors were associated with younger age.
CONCLUSION
Factors that varied with age of death are well-documented risk factors for SUID. The majority of these risk factors were associated with younger age at death after allowing for gestational age at birth.
Topics: Aged; Asphyxia; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Pregnancy; Risk Factors; Smoking; Sudden Infant Death
PubMed: 32304589
DOI: 10.1111/apa.15308 -
La Pediatria Medica E Chirurgica :... 2004Sudden Infant Death Syndrome (SIDS) is the term first proposed in 1969 for a distinctive subgroup of unexpected infant deaths occurring during the first months of life,... (Comparative Study)
Comparative Study Review
Sudden Infant Death Syndrome (SIDS) is the term first proposed in 1969 for a distinctive subgroup of unexpected infant deaths occurring during the first months of life, with relatively consistent clinical, epidemiological and pathological features, which remain unexplained after a thorough case investigation, including a complete autopsy, examination of death scene and review of clinical history. Sudden infant death unnecessary means SIDS. According to definition, SIDS remains a diagnosis of exclusion, distinguished from others only by subjective and permissive variables. Despite the vague and permissive nature of the definition, epidemiological studies identified some risk factors as prematurity and social disadvantage. Nevertheless, the most interesting findings are those related to environmental and care features, as drug addiction and/or smoke exposition during pregnancy, sleep position of the infant, environmental temperature, parental bed sharing and breast feeding. Those factors play a variable role, but their correction reduced SIDS incidence. Sudden infant death is a diagnosis made by expert pathologists with pediatrician's and investigator's advice, based primarily on autopsy findings and death scene investigation performed through the severe application of investigative protocols.
Topics: Female; Gestational Age; Humans; Incidence; Infant; Infant, Newborn; Maternal Age; Pregnancy; Risk Factors; Socioeconomic Factors; Sudden Infant Death
PubMed: 15700732
DOI: No ID Found