Sudden unexpected death in epilepsy. Review about the brainstem involvement

Abstract

Sudden unexpected death in epilepsy is defined as the sudden death—whether witnessed or not—of people with epilepsy, not traumatic or due to drowning, with or without evidence of seizures, and in whom postmortem examination does not reveal a structural or toxicological cause of death. The aim of this review is to describe the most recent evidence published in the literature, on the crucial involvement of the brain stem in the pathophysiology of sudden unexpected death in epilepsy. A bibliographic search was conducted in PubMed computerized database. Studies in animal models have shown that the mechanisms of sudden unexpected death in epilepsy involve a first seizure-mediated event, followed by cortical depolarization, which spreads to the brainstem and results in autonomic dysfunction causing central apnea, pulmonary edema or cardiac arrhythmia. Studies in humans have relied on magnetic resonance imaging to assess the role of the brainstem in sudden unexpected death in epilepsy. The evidence accumulated in the literature, both in animal and in human studies, shows the role played by brainstem structures in the pathophysiology of sudden unexpected death in epilepsy.