SUDEP 最新回顾：风险评估、背景和癫痫发作检测设备。

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS

ACS Applied Bio Materials Pub Date : 2024-10-08 DOI:10.1016/j.yebeh.2024.109966

C.P.J.A. Monté , J.B.A.M. Arends , R.H.C. Lazeron , I.Y. Tan , P.A.J.M. Boon

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引用次数: 0

摘要

本综述重点关注癫痫患者的意外猝死（SUDEP），并将风险分层（通过 SUDEP 风险因素和 SUDEP 风险评分）、SUDEP 的机制假设以及符合条件的癫痫发作检测设备 (SDD) 纳入进一步的 SUDEP 预防研究。发生 SUDEP 的主要风险因素是全身强直-阵挛发作 (GTC) 的存在和频率。在瑞典的人群病例对照研究中，在不共用卧室的情况下出现 GTC 的几率为 67。SUDEP 风险评分系统给出的分数代表了 SUDEP 风险因素的累积情况，但并不代表这些因素组合的确切效果。我们介绍了 4 种可用的评分系统：SUDEP-7 清单、SUDEP-3 清单、SUDEP-ClinicAl Risk scorE（SUDEP-CARE 评分）和 Kempenhaeghe SUDEP 风险评分。虽然它们都包含 GTC，但其设计往往不同。4 个评分系统中有 3 个经过验证（SUDEP-7 清单、SUDEP-3 清单和 SUDEP-CARE 评分）。现有的评分系统中没有一个经过充分验证，可用于普通癫痫人群。讨论了 SUDEP 的合理机制。在 MORTEMUS-研究（癫痫监测单位死亡率研究）中，SUDEP 是在 GTC 后发作性心肺功能停止。SUDEP 同时伴有呼吸和心脏功能障碍，这表明参与呼吸和心律控制的脑干中枢出现了中枢功能障碍。根据腺苷-血清素假说，当发作后腺苷介导的呼吸抑制不能被血清素的作用所补偿时，就会发生 SUDEP。本文还讨论了其他（辅助）机制和因素。癫痫发作检测装置（SDD）有助于改善夜间监护。三期研究已验证了五种用于检测 TC 的 SDD：Seizure Link®、Epi-Care®、NightWatch、Empatica 和 Nelli®。它们的灵敏度至少达到 90%，误报率也在可接受范围内。虽然尚未证明使用这种仪器确实能预防 SUDEP，但临床经验证明了它们的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Update review on SUDEP: Risk assessment, background & seizure detection devices

This review focusses on sudden unexpected death in epilepsy patients (SUDEP) and incorporates risk stratification (through SUDEP risk factors and SUDEP risk scores), hypotheses on the mechanism of SUDEP and eligible seizure detection devices (SDDs) for further SUDEP prevention studies.

The main risk factors for SUDEP are the presence and the frequency of generalized tonic-clonic seizures (GTC). In Swedish population-based case control study, the Odds ratio of the presence of GTC in the absence of bedroom sharing is 67.

SUDEP risk scoring systems express a score that represents the cumulative presence of SUDEP risk factors, but not the exact effect of their combination. We describe 4 of the available scoring systems: SUDEP-7 inventory, SUDEP-3 inventory, SUDEP-ClinicAl Risk scorE (SUDEP-CARE score) and Kempenhaeghe SUDEP risk score. Although they all include GTC, their design is often different. Three of 4 scoring systems were validated (SUDEP-7 inventory, SUDEP-3 inventory and SUDEP-CARE score). None of the available scoring systems has been sufficiently validated for the use in a general epilepsy population.

Plausible mechanisms of SUDEP are discussed. In the MORTEMUS-study (Mortality in Epilepsy Monitoring Unit Study), SUDEP was a postictal cardiorespiratory arrest after a GTC. The parallel respiratory and cardiac dysfunction in SUDEP suggests a central dysfunction of the brainstem centers that are involved in the control of respiration and heart rhythm. In the (consequent) adenosine serotonin hypotheses SUDEP occurs when a postictal adenosine-mediated respiratory depression is not compensated by the effect of serotonin. Other (adjuvant) mechanisms and factors are discussed.

Seizure detection devices (SDDs) may help to improve nocturnal supervision. Five SDDs have been validated in phase 3 studies for the detection of TC: Seizure Link®, Epi-Care®, NightWatch, Empatica, Nelli®. They have demonstrated a sensitivity of at least 90 % combined with an acceptable false positive alarm rate. It has not yet been proven that the use will actually lead to SUDEP prevention, but clinical experience supports their effectiveness.

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来源期刊

ACS Applied Bio Materials Chemistry-Chemistry (all)

CiteScore

9.40

自引率

2.10%

发文量

464