ABSTRACT
In addition to general and neurological risk factors, there is increasing evidence that cardiac (Aurlien et al. 2009; Kerling et al. 2009; Pezzella et al. 2009; Strzelczyk et al. 2008) and pulmonary comorbidities are predisposing factors (Scorza et al. 2007; Tavee and Morris 2008) for sudden unexplained death in epilepsy (SUDEP). As with general risk factors (young age, male sex, Dravet syndrome, being in bed, cold temperature) and neurological risk factors [early-onset epilepsy (long duration of epilepsy), severity of epilepsy (presence of tonic-clonic seizures), poor seizure control, high seizure frequency, increased number of antiepileptic drugs, subtherapeutic levels of antiepileptic drugs, frequent modications of antiepileptics, noncompliance with antiepileptics, presence of aberrant neurogenesis], the
42.1 Introduction 679 42.2 Cardiac Risk Factors of SUDEP 680
42.2.1 Channelopathies 680 42.2.2 Cardiotoxic Drugs 681 42.2.3 Other Possible Cardiac Risk Factors 682
42.3 Cardiac Pathomechanisms 683 42.3.1 Ictal Arrhythmias 684
42.3.1.1 Bradyarrhythmias and Asystole 684 42.3.1.2 Tachyarrhythmias 685 42.3.1.3 Autonomic Mechanisms 685
42.3.2 Systolic Dysfunction 686 42.4 Pulmonary Risk Factors of SUDEP 686 42.5 Respiratory Pathomechanisms 687 42.6 Clinical Implications 687
42.6.1 Interictal 687 42.6.2 Ictal 688 42.6.3 Postictal 688
42.7 Conclusion 688 References 689
relevance of cardiac and pulmonary risk factors has not been investigated by prospective observational follow-up studies or by intervention studies, and the evidence for specic risk factors and pathomechanisms is still not established (Johnston and Smith 2007). e goal of this chapter is to highlight and discuss recent ndings and practical implications concerning potential cardiac and pulmonary risk factors and pathomechanisms of SUDEP.
