Frequency of Mortality and Sudden Unexpected Death in Patients with Uncontrolled Epilepsy Underwent Epilepsy Surgery in Kashani Hospital, Isfahan, Iran, during the Years 2007 to 2017

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Neurologist, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

5 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Epilepsy is one of the most prevalent neurologic disorders in all ages. Epilepsy surgery is widely prescribed for patients with refractory epilepsy, and can control seizure episodes. Controlling seizures is associated with decrease in mortality in these patients. This study aimed to evaluate the prevalence of sudden unexpected death in epilepsy (SUDEP) in patients with refractory epilepsy underwent epilepsy surgery.Methods: This was a descriptive epidemiologic study on patients with uncontrolled epilepsy underwent epilepsy surgery in Kashani hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, during the years 2007-2017. They were under long term video electroencephalogram (video EEG) monitoring for presurgical evaluation in Kashani hospital epilepsy center. Patient's records were given from hospital archives, and evaluated for demographic and epilepsy data. Then, telephone call was made to assess the presence of mortality in patients and its causes, and the frequency of mortality and sudden unexpected death was calculated.Findings: In this study, 324 patients with refractory epilepsy, who underwent epilepsy surgery, with mean age of 29.2 ± 9.8 years were evaluated; 59.3% of them were men. The total incidence of mortality was 2.3% (3 cases), and none of them were sudden unexpected death. There was significant and non-significant association between incidence of mortality with gender and age, respectively. The causes of death were tumor recurrence (2 cases) and intracranial hemorrhage during the surgery (1 case).Conclusion: The frequency of sudden unexpected death among the epilepsy patients underwent epilepsy surgery in Iran is lower than other countries.

Keywords

References

  1. Kanner AM, Ashman E, Gloss D, Harden C, Bourgeois B, Bautista JF, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2018; 91(2): 82-90.
  2. Banerjee PN, Filippi D, Allen HW. The descriptive epidemiology of epilepsy-a review. Epilepsy Res 2009; 85(1): 31-45.
  3. Ngugi AK, Kariuki SM, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Incidence of epilepsy: A systematic review and meta-analysis. Neurology 2011; 77(10): 1005-12.
  4. Schuele SU, Luders HO. Intractable epilepsy: Management and therapeutic alternatives. Lancet Neurol 2008; 7(6): 514-24.
  5. Engel J, Jr., Wiebe S, French J, Sperling M, Williamson P, Spencer D, et al. Practice parameter: Temporal lobe and localized neocortical resections for epilepsy: Report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology 2003; 60(4): 538-47.
  6. So EL, Radhakrishnan K, Silbert PL, Cascino GD, Sharbrough FW, O'Brien PC. Assessing changes over time in temporal lobectomy: Outcome by scoring seizure frequency. Epilepsy Res 1997; 27(2): 119-25.
  7. Tellez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: A systematic review and meta-analysis. Brain 2005; 128(Pt 5): 1188-98.
  8. Tonini C, Beghi E, Berg AT, Bogliun G, Giordano L, Newton RW, et al. Predictors of epilepsy surgery outcome: A meta-analysis. Epilepsy Res 2004; 62(1): 75-87.
  9. Terra VC, Machado HR, Sakamoto AC, Arida RM, Cavalheiro EA, Scorza FA. Epilepsy surgery could be considered a line of defense against sudden unexpected death in epilepsy. Childs Nerv Syst 2009; 25(6): 645-6.
  10. Devinsky O. Sudden, unexpected death in epilepsy. N Engl J Med 2011; 365(19): 1801-11.
  11. Nashef L. Sudden unexpected death in epilepsy: terminology and definitions. Epilepsia 1997; 38(11 Suppl): S6-S8.
  12. Tomson T, Walczak T, Sillanpaa M, Sander JW. Sudden unexpected death in epilepsy: A review of incidence and risk factors. Epilepsia 2005; 46(Suppl 11): 54-61.
  13. Guldvog B, Loyning Y, Hauglie-Hanssen E, Flood S, Bjornaes H. Surgical treatment for partial epilepsy among Norwegian adults. Epilepsia 1994; 35(3): 540-53.
  14. Sperling MR, Feldman H, Kinman J, Liporace JD, O'Connor MJ. Seizure control and mortality in epilepsy. Ann Neurol 1999; 46(1): 45-50.
  15. Mansouri A, Alhadid K, Valiante TA. Sudden unexpected death in epilepsy following resective epilepsy surgery in two patients withdrawn from anticonvulsants. J Clin Neurosci 2015; 22(9): 1505-6.
  16. Kerling F, Pauli E, Lorber B, Blumcke I, Buchfelder M, Stefan H. Drug withdrawal after successful epilepsy surgery: How safe is it? Epilepsy Behav 2009; 15(4): 476-80.
  17. Rathore C, Panda S, Sarma PS, Radhakrishnan K. How safe is it to withdraw antiepileptic drugs following successful surgery for mesial temporal lobe epilepsy? Epilepsia 2011; 52(3): 627-35.
  18. Nashef L, Fish DR, Sander JW, Shorvon SD. Incidence of sudden unexpected death in an adult outpatient cohort with epilepsy at a tertiary referral centre. J Neurol Neurosurg Psychiatry 1995; 58(4): 462-4.
  19. Dasheiff RM. Sudden unexpected death in epilepsy: A series from an epilepsy surgery program and speculation on the relationship to sudden cardiac death. J Clin Neurophysiol 1991; 8(2): 216-22.
  20. Nilsson L, Farahmand BY, Persson PG, Thiblin I, Tomson T. Risk factors for sudden unexpected death in epilepsy: A case-control study. Lancet 1999; 353(9156): 888-93.
  21. Nilsson L, Ahlbom A, Farahmand BY, Tomson T. Mortality in a population-based cohort of epilepsy surgery patients. Epilepsia 2003; 44(4): 575-81.
  22. Hennessy MJ, Langan Y, Elwes RD, Binnie CD, Polkey CE, Nashef L. A study of mortality after temporal lobe epilepsy surgery. Neurology 1999; 53(6): 1276-83.
  23. Kim YD, Heo K, Park SC, Huh K, Chang JW, Choi JU, et al. Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy. Epilepsia 2005; 46(2): 251-7.
  24. Seymour N, Granbichler CA, Polkey CE, Nashef L. Mortality after temporal lobe epilepsy surgery. Epilepsia 2012; 53(2): 267-71.
  25. Salanova V, Markand O, Worth R. Temporal lobe epilepsy surgery: Outcome, complications, and late mortality rate in 215 patients. Epilepsia 2002; 43(2): 170-4.
Journal of Isfahan Medical School
Volume 36, Issue 491 - Serial Number 491
July and August 2018
Pages 924-929

Files

History

  • Receive Date: 03 July 2018
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics