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Sudden Unexpected Death in Epilepsy (SUDEP)

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Handbook of Neurodegenerative Disorders

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Abstract

Sudden unexpected death in epilepsy (SUDEP) is a common cause of premature mortality among people with epilepsy (PWE). The overall incidence rate of SUDEP is around 1.2 per 1000 person-years overall, although this may vary across different populations. SUDEP represents a significant public health burden as PWE experience a higher mortality risk compared to the general population. This chapter aims to discuss the latest advancements in risk factors, mechanisms underlying SUDEP, and possible strategies to prevent its occurrence.

Multiple risk factors have been proposed to contribute to an increased SUDEP risk, including high generalized tonic-clonic seizure (GTCS) frequency, treatment adherence, age of epilepsy onset, alcohol abuse, slee** in a prone position, and intellectual disability. However, the interpretation of studies investigating risk factors remains a challenge due to variations in methodologies and populations. Despite the complexity of SUDEP, various mechanisms have been proposed. Postictal generalized EEG suppression (PGES) and impairment in serotonin modulation reflect dysfunctions in the brainstem, which may affect autonomic functions. Alterations in cardiorespiratory function, including bradycardia, hypoxemia, and apnea, have also been proposed as mechanisms of SUDEP. Controlling seizures may help to prevent SUDEP since high GTCS frequency is known to be a prominent risk factor. By providing more information about the risk of SUDEP, patients and caregivers can be empowered to adopt behavioral modifications for prevention. While other preventive measures have also been explored, such as nocturnal supervision, seizure alarms, and anti-suffocation pillows, whether or not these are effective in preventing SUDEP remains a debate.

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Authors and Affiliations

  1. Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia

    Eryse Amira Seth, Alina Arulsamy & Mohd Farooq Shaikh

  2. Department of Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia

    Ching Soong Khoo

  3. School of Dentistry and Medical Sciences, Charles Sturt University, Orange, NSW, Australia

    Mohd Farooq Shaikh

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  1. Eryse Amira Seth
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  4. Mohd Farooq Shaikh
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Correspondence to Mohd Farooq Shaikh .

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  1. Coll of Agricultural & Marine Sciences, Sultan Qaboos University, Muscat, Oman

    Essa Mohamed

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  1. Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia

    Mohd. Farooq Shaikh

  2. School of Dentistry and Medical Sciences, Charles Sturt University, Orange, NSW, Australia

    Mohd. Farooq Shaikh

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Seth, E.A., Khoo, C.S., Arulsamy, A., Shaikh, M.F. (2024). Sudden Unexpected Death in Epilepsy (SUDEP). In: Mohamed, E. (eds) Handbook of Neurodegenerative Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-19-3949-5_26-1

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