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Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study

(2013) LANCET NEUROLOGY. 12(10). p.966-977
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Abstract
Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods: Between Jan 1,2008, and Dec 29,2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings: 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5.1 (95% CI 2.6-9.2) per 1000 patient-years, with a risk of 1.2 (0.6-2.1) per 10 000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time.
Keywords
GENERALIZED EEG SUPPRESSION, SUDDEN UNEXPECTED DEATH, LOCALIZATION-RELATED EPILEPSY, UNEXPLAINED DEATH, ADVERSE EVENTS, RESPIRATORY DYSFUNCTION, CONVULSIVE SEIZURES, CARDIAC-ARRHYTHMIA, RISK-FACTORS, SUDEP

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MLA
Ryvlin, Philippe, Lina Nashef, Samden D Lhatoo, et al. “Incidence and Mechanisms of Cardiorespiratory Arrests in Epilepsy Monitoring Units (MORTEMUS): a Retrospective Study.” LANCET NEUROLOGY 12.10 (2013): 966–977. Print.
APA
Ryvlin, P., Nashef, L., Lhatoo, S. D., Bateman, L. M., Bird, J., Bleasel, A., Boon, P., et al. (2013). Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. LANCET NEUROLOGY, 12(10), 966–977.
Chicago author-date
Ryvlin, Philippe, Lina Nashef, Samden D Lhatoo, Lisa M Bateman, Jonathan Bird, Andrew Bleasel, Paul Boon, et al. 2013. “Incidence and Mechanisms of Cardiorespiratory Arrests in Epilepsy Monitoring Units (MORTEMUS): a Retrospective Study.” Lancet Neurology 12 (10): 966–977.
Chicago author-date (all authors)
Ryvlin, Philippe, Lina Nashef, Samden D Lhatoo, Lisa M Bateman, Jonathan Bird, Andrew Bleasel, Paul Boon, Arielle Crespel, Barbara A Dworetzky, Hans Hogenhaven, Holger Lerche, Louis Maillard, Michael P Molter, Cecile Marchal, Jagarlapudi MK Murthy, Michael Nitsche, Ekaterina Pataraia, Tede Rabben, Sylvain Rheims, Bernard Sadzot, Andreas Schulze-Bonhage, Masud Seyal, Elson L So, Mark Spitz, Anna Szucs, Meng Tan, James X Tao, and Torbjorn Tomson. 2013. “Incidence and Mechanisms of Cardiorespiratory Arrests in Epilepsy Monitoring Units (MORTEMUS): a Retrospective Study.” Lancet Neurology 12 (10): 966–977.
Vancouver
1.
Ryvlin P, Nashef L, Lhatoo SD, Bateman LM, Bird J, Bleasel A, et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. LANCET NEUROLOGY. 2013;12(10):966–77.
IEEE
[1]
P. Ryvlin et al., “Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study,” LANCET NEUROLOGY, vol. 12, no. 10, pp. 966–977, 2013.
@article{4207737,
  abstract     = {Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide.
Methods: Between Jan 1,2008, and Dec 29,2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available.
Findings: 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5.1 (95% CI 2.6-9.2) per 1000 patient-years, with a risk of 1.2 (0.6-2.1) per 10 000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal.
Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time.},
  author       = {Ryvlin, Philippe and Nashef, Lina and Lhatoo, Samden D and Bateman, Lisa M and Bird, Jonathan and Bleasel, Andrew and Boon, Paul and Crespel, Arielle and Dworetzky, Barbara A and Hogenhaven, Hans and Lerche, Holger and Maillard, Louis and Molter, Michael P and Marchal, Cecile and Murthy, Jagarlapudi MK and Nitsche, Michael and Pataraia, Ekaterina and Rabben, Tede and Rheims, Sylvain and Sadzot, Bernard and Schulze-Bonhage, Andreas and Seyal, Masud and So, Elson L and Spitz, Mark and Szucs, Anna and Tan, Meng and Tao, James X and Tomson, Torbjorn},
  issn         = {1474-4422},
  journal      = {LANCET NEUROLOGY},
  keywords     = {GENERALIZED EEG SUPPRESSION,SUDDEN UNEXPECTED DEATH,LOCALIZATION-RELATED EPILEPSY,UNEXPLAINED DEATH,ADVERSE EVENTS,RESPIRATORY DYSFUNCTION,CONVULSIVE SEIZURES,CARDIAC-ARRHYTHMIA,RISK-FACTORS,SUDEP},
  language     = {eng},
  number       = {10},
  pages        = {966--977},
  title        = {Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study},
  url          = {http://dx.doi.org/10.1016/S1474-4422(13)70214-X},
  volume       = {12},
  year         = {2013},
}

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