1. Left-insular damage, autonomic instability, and sudden unexpected death in epilepsy
- Author
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Wanchat Theerannaew, Curtis Tatsuoka, Kenneth A. Loparo, Samden D. Lhatoo, Jayakumar Sahadevan, Nuria Lacuey, and Bilal Zonjy
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,AUTONOMIC INSTABILITY ,Unexpected death ,behavioral disciplines and activities ,Article ,03 medical and health sciences ,Behavioral Neuroscience ,Epilepsy ,Death, Sudden ,0302 clinical medicine ,Heart Rate ,Risk Factors ,Internal medicine ,Heart rate ,medicine ,Heart rate variability ,Humans ,In patient ,Risk factor ,Cerebral Cortex ,medicine.disease ,030104 developmental biology ,Neurology ,nervous system ,Autonomic Nervous System Diseases ,Anesthesia ,Cardiology ,behavior and behavior mechanisms ,Neurology (clinical) ,Psychology ,Insula ,030217 neurology & neurosurgery ,psychological phenomena and processes - Abstract
We analyzed the only two sudden unexpected death in epilepsy (SUDEP) cases from 320 prospectively recruited patients in the three-year Prevention and Risk Identification of SUDEP Mortality (PRISM) project. Both patients had surgically refractory epilepsy, evidence of left insular damage following previous temporal/temporo-insular resections, and progressive changes in heart rate variability (HRV) in monitored evaluations prior to death. Insular damage is known to cause autonomic dysfunction and increased mortality in acute stroke. This report suggests a possible role for the insula in the pathogenesis of SUDEP. The presence of intrinsic insular lesions or acquired insular damage in patients with refractory epilepsy may be an additional risk factor for SUDEP.
- Published
- 2015