학술논문
Seizures with Autonomic Symptoms and Sudden Unexpected Death in Epilepsy (SUDEP)/Otonom Semptomlu Nobetler ve Epilepside Beklenmeyen Ani Olumler (SUDEP)
Document Type
Academic Journal
Source
Turkish Journal of Neurology. September 2019, Vol. 25 Issue 3, p109, 8 p.
Subject
Language
English
ISSN
1301-062X
Abstract
Introduction The Autonomic Nervous System and Cerebral Function of the Autonomic Nervous System The autonomic nervous system is a system that regulates the physiologic processes of human beings without conscious [...]
The autonomic nervous system, formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of internal organs. The hypothalamus is the main center responsible for the autonomic functions in the central nervous system. Other anatomical structures can be listed as cingulate gyrus, amygdala, paraventricular nucleus. The central autonomic network involved in the pathophysiology of autonomous epilepsy is represented in the non-dominant hemisphere. Autonomic seizures are shown in temporal and insular lobe epilepsies commonly. Blood pressure changes, heart rhythm disturbances (tachycardia, bradycardia, arrhythmia, asystole), respiratory changes (apnea, hypopnea, bradypnea), salivation increase, vomiting/retching, pilo-erection, sweating increase, mydriasis/miosis, spitting, water drinking, genital automatism, intestinal motility disorders are clinical signs in autonomic epilepsy. SUDEP (sudden unexpected death in epilepsy) is defined as sudden, unexpected, nontraumatic, non-drowning death in an individual with epilepsy, witnessed or unwitnessed, in which post-mortem examination does not reveal an anatomical or toxicological cause of death. The vast majority of SUDEPs occur in the aftermath of a generalised tonic-clonic seizure. It's responsible for 17% of deaths in epileptic patients. Witnessed recorded SUDEP cases involve postictal cardiorespiratory dysfunction with failure of arousal. It is reported that the threshold value of SpO is 80-86% for the risk of sudden death. While patients who have had seizures remotely and have had successful epilepsy surgeries also carry the SUDEP risk, the most important risk factor is a history of generalised tonic-clonic seizures. Keywords: Autonomic seizures, epilepsy, SUDEP Otonom sinir sistemi bilincli kontrolun olmadigi bir sistemdir. Sempatik ve parasempatik olmak uzere iki bolumden olusur. Santral sinir sisteminde otonom sistemden sorumlu ana merkez hipotalamustur. Otonom nobet semiyolojisinde rol alan diger anatomik yapilar singulat girus, amigdala, paraventrikuler nukleustur. Otonom epilepsilerin fizyopatolojisinde yer alan santral otonom ag non-dominant hemisferde temsil edilirken otonom bulgular temporal ve insuler lob epilepsilerde siktir. Hastalarda klinik olarak; kan basinci degisiklikleri, kalp ritim bozukluklari (tasikardi, bradikardi, aritmi, asistoli), solunumsal degisiklikler (apne, hipopne, bradipne), tukuruk artisi, kusma/ogurme, pilo-ereksiyon, terleme artisi, midriazis/miyozis, tukurme, acil miksiyon, su icme, genital otomatizm, barsak motilite bozukluklari nobet oncesi/sirasi/ve sonrasinda gorulebilen otonom semptomlardir; temporal lob epilepsisinde daha siktir. Otonom nobetli hastalarin ani olum riski de diger epilepsi hastalarina gore daha fazladir. Epilepside ani beklenmedik olum (SUDEP); epilepsi hastasinda bogulma, travma ve status epileptikus dislandiktan sonra; ani, beklenmedik, gorgu tanigi ya da olum sirasinda nobet kaniti olsun olmasin meydana gelen; postmortem incelemelerde olume neden olan yapisal veya toksik bir sebep saptanmayan olum olarak tanimlanir; epilepsideki olumlerin %17'sinden sorumludur. SUDEP'nin etiyolojisinde; altta yatan postiktal kardiyorespiratuvar disfonksiyon oldugu one surulur. Ani olum riski icin SpO2 esik degerinin %80-86 oldugu bildirilirken, iktal olaylar, otonom sistemin kronik aktivasyonu nedeniyle olumcul aritmileri tetiklerler. Ozellikle uykuda olan jeneralize tonik klonik nobetler, direncli epilepsiler SUDEP ile ilgilendirilen risk faktorlerindendir. Kardiyorespiratuvar bulgulu otonom semptomlu nobetlere bu risklere katkida bulunabilecegi acisindan dikkat edilmelidir. Anahtar Kelimeler: Otonom nobetler, epilepsi, SUDEP
The autonomic nervous system, formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of internal organs. The hypothalamus is the main center responsible for the autonomic functions in the central nervous system. Other anatomical structures can be listed as cingulate gyrus, amygdala, paraventricular nucleus. The central autonomic network involved in the pathophysiology of autonomous epilepsy is represented in the non-dominant hemisphere. Autonomic seizures are shown in temporal and insular lobe epilepsies commonly. Blood pressure changes, heart rhythm disturbances (tachycardia, bradycardia, arrhythmia, asystole), respiratory changes (apnea, hypopnea, bradypnea), salivation increase, vomiting/retching, pilo-erection, sweating increase, mydriasis/miosis, spitting, water drinking, genital automatism, intestinal motility disorders are clinical signs in autonomic epilepsy. SUDEP (sudden unexpected death in epilepsy) is defined as sudden, unexpected, nontraumatic, non-drowning death in an individual with epilepsy, witnessed or unwitnessed, in which post-mortem examination does not reveal an anatomical or toxicological cause of death. The vast majority of SUDEPs occur in the aftermath of a generalised tonic-clonic seizure. It's responsible for 17% of deaths in epileptic patients. Witnessed recorded SUDEP cases involve postictal cardiorespiratory dysfunction with failure of arousal. It is reported that the threshold value of SpO is 80-86% for the risk of sudden death. While patients who have had seizures remotely and have had successful epilepsy surgeries also carry the SUDEP risk, the most important risk factor is a history of generalised tonic-clonic seizures. Keywords: Autonomic seizures, epilepsy, SUDEP Otonom sinir sistemi bilincli kontrolun olmadigi bir sistemdir. Sempatik ve parasempatik olmak uzere iki bolumden olusur. Santral sinir sisteminde otonom sistemden sorumlu ana merkez hipotalamustur. Otonom nobet semiyolojisinde rol alan diger anatomik yapilar singulat girus, amigdala, paraventrikuler nukleustur. Otonom epilepsilerin fizyopatolojisinde yer alan santral otonom ag non-dominant hemisferde temsil edilirken otonom bulgular temporal ve insuler lob epilepsilerde siktir. Hastalarda klinik olarak; kan basinci degisiklikleri, kalp ritim bozukluklari (tasikardi, bradikardi, aritmi, asistoli), solunumsal degisiklikler (apne, hipopne, bradipne), tukuruk artisi, kusma/ogurme, pilo-ereksiyon, terleme artisi, midriazis/miyozis, tukurme, acil miksiyon, su icme, genital otomatizm, barsak motilite bozukluklari nobet oncesi/sirasi/ve sonrasinda gorulebilen otonom semptomlardir; temporal lob epilepsisinde daha siktir. Otonom nobetli hastalarin ani olum riski de diger epilepsi hastalarina gore daha fazladir. Epilepside ani beklenmedik olum (SUDEP); epilepsi hastasinda bogulma, travma ve status epileptikus dislandiktan sonra; ani, beklenmedik, gorgu tanigi ya da olum sirasinda nobet kaniti olsun olmasin meydana gelen; postmortem incelemelerde olume neden olan yapisal veya toksik bir sebep saptanmayan olum olarak tanimlanir; epilepsideki olumlerin %17'sinden sorumludur. SUDEP'nin etiyolojisinde; altta yatan postiktal kardiyorespiratuvar disfonksiyon oldugu one surulur. Ani olum riski icin SpO2 esik degerinin %80-86 oldugu bildirilirken, iktal olaylar, otonom sistemin kronik aktivasyonu nedeniyle olumcul aritmileri tetiklerler. Ozellikle uykuda olan jeneralize tonik klonik nobetler, direncli epilepsiler SUDEP ile ilgilendirilen risk faktorlerindendir. Kardiyorespiratuvar bulgulu otonom semptomlu nobetlere bu risklere katkida bulunabilecegi acisindan dikkat edilmelidir. Anahtar Kelimeler: Otonom nobetler, epilepsi, SUDEP