Sudden Unexpected Death in Epilepsy: Central Respiratory Chemoreception
International Journal of Molecular Sciences,
Год журнала:
2025,
Номер
26(4), С. 1598 - 1598
Опубликована: Фев. 13, 2025
Sudden
unexpected
death
in
epilepsy
(SUDEP)
is
a
critical
concern
for
individuals
suffering
from
epilepsy,
with
respiratory
dysfunction
playing
significant
role
its
pathology.
Fatal
seizures
are
often
characterized
by
central
apnea
and
hypercapnia
(elevated
CO2
levels),
indicating
failure
ventilatory
control.
Research
has
shown
that
both
human
patients
animal
models
exhibit
reduced
hypercapnic
response
the
interictal
(non-seizure)
period,
suggesting
an
impaired
ability
to
regulate
breathing
high
levels.
This
review
examines
of
chemoreceptors-specifically
retrotrapezoid
nucleus,
raphe
nuclei,
nucleus
tractus
solitarius,
locus
coeruleus,
hypothalamus
this
These
structures
sensing
maintaining
homeostasis.
Emerging
evidence
also
implicates
neuropeptidergic
pathways
within
these
chemoreceptive
regions
SUDEP.
Neuropeptides
like
galanin,
pituitary
adenylate
cyclase-activating
peptide
(PACAP),
orexin,
somatostatin,
bombesin-like
peptides
may
modulate
chemosensitivity
function,
potentially
exacerbating
during
seizures.
Understanding
mechanisms
linking
chemoreception,
control,
signaling
essential
developing
targeted
interventions
reduce
risk
SUDEP
patients.
Язык: Английский
Sudden Unexpected Death in Epilepsy: A Narrative Review of Mechanism, Risks, and Prevention
Journal of Clinical Medicine,
Год журнала:
2025,
Номер
14(10), С. 3329 - 3329
Опубликована: Май 10, 2025
Sudden
unexpected
death
in
epilepsy
(SUDEP)
is
sudden,
unexpected,
witnessed
or
unwitnessed,
nontraumatic,
non-drowning
that
occurs
a
person
with
epilepsy.
SUDEP
the
leading
cause
of
epilepsy-related
adults
epilepsy,
an
incidence
about
1.2
per
1000
person-years
general
population.
Recent
studies
have
shown
similar
prevalence
pediatric
population
too.
Although
precise
mechanism
remains
unclear,
well-documented
cases
suggest
generalized
tonic
clonic
seizure-induced,
centrally
mediated
change
cardiorespiratory
function
leads
to
terminal
apnea
and
cardiac
arrest.
Risk
factors
include
seizure
frequency,
duration
nocturnal
seizure,
certain
genetic
syndromes.
Orexin,
adenosine,
serotonin
neurotransmission
been
explored
as
novel
drug
targets
mitigate
risk.
Neurostimulation
resective
surgery
reported
beneficial
effects
on
long-term
risk
well.
Future
may
aim
clarify
role
sleep
other
comorbidities
pathophysiology.
Язык: Английский
Diaphragm relaxation causes seizure-related apnoeas in chronic and acute seizure models in rats
Neurobiology of Disease,
Год журнала:
2024,
Номер
203, С. 106735 - 106735
Опубликована: Ноя. 14, 2024
Ictal
central
apnoea
is
a
feature
of
focal
temporal
seizures.
It
implicated
as
risk
factor
for
sudden
unexpected
death
in
epilepsy
(SUDEP).
Here
we
study
seizure-related
apnoeas
two
different
models
experimental
seizures,
one
chronic
and
acute,
adult
genetically-unmodified
rats,
to
determine
mechanisms
apnoeas.
Under
general
anaesthesia
rats
receive
sensors
nasal
temperature,
hippocampal
and/or
neocortical
potentials,
ECG
or
EMG
subsequent
tethered
video-telemetry.
Tetanus
neurotoxin
(TeNT),
injected
into
hippocampus
during
surgery,
induces
epileptic
focus.
Other
implanted
intraperitoneal
pentylenetetrazol
(PTZ)
evoke
acute
In
chronically
convulsive
seizures
cause
(9.9
±
5.3
s;
331
730
15
rats),
associated
with
bradyarrhythmias.
Absence
EEG
biomarkers
exclude
obstructive
All
eight
TeNT-rats
diaphragm
have
no
evidence
obstruction,
EMGs
significantly
closer
expiratory
relaxation
than
inspiratory
contraction
pre-apnoeic
respiration,
which
term
"atonic
diaphragm".
Consistent
atonic
that
the
airflow
expiration,
it
human
ictal
apnoea.
Two
cases
rat
occur.
One,
telemetry
end,
reveals
lethal
apnoea,
other
only
has
video
final
days,
cessation
breathing
shortly
after
last
clonic
movement.
Telemetry
following
systemic
PTZ
repeated
apnoeas,
culminating
apnoeas;
are
-
8
35
diaphragms
initially
contract
tonically
8.5
15.0
s
before
relaxing,
27
remaining
throughout
terminal
atonic.
Differences
types
due
(mainly
atonic)
mice
(tonic)
likely
species-specific.
Certain
genetic
mouse
caused
by
tonic
contraction,
potentially
expression
epileptogenic
mutations
brain,
including
respiratory
centres,
contrast
acquired
epilepsies.
We
conclude
TeNT
model
result
from
diaphragms.
Relaxed
could
be
particularly
helpful
therapeutic
stimulation
help
restore
respiration.
Язык: Английский