Epidemiologie, Pathophysiologie und Prävention des SUDEP

Zusammenfassung

Der plötzliche und unerwartete Tod bei Epilepsie (SUDEP) ist eine häufige Ursache für das vorzeitige Versterben von Menschen mit Epilepsie. Die meisten SUDEP-Fälle ereignen sich nachts bzw. sind oft unbeobachtet, sodass die zugrundeliegenden Pathomechanismen nicht abschließend geklärt sind. Es wird jedoch vermutet, dass der SUDEP in den meisten Fällen eine tödliche Komplikation epileptischer Anfälle ist. Nach den bisherigen Erkenntnissen beruht er auf einer Suppression der Herz- und Atmungstätigkeit in der frühen Phase nach generalisierten tonisch-klonischen Anfällen, welche schließlich in einem terminalen Herzkreislaufstillstand endet. Verschiedene Faktoren scheinen das SUDEP-Risiko zu erhöhen. So sind junge männliche Erwachsene mit unkontrollierten generalisierten tonisch-klonischen Anfällen besonders gefährdet, an einem SUDEP zu versterben. Gegenstand derzeitiger Forschung sind u. a. mögliche genetische Ursachen sowie strukturelle und funktionelle Hirnfunktionsstörungen, woraus künftig ggf. Biomarker abgeleitet werden, die zur individuellen Risikoeinschätzung beitragen können. Die effektive medikamentöse Therapie ist die bisher einzige evidenzbasierte Präventionsmaßnahme. Wahrscheinlich kann eine nächtliche Supervision das SUDEP-Risiko reduzieren und eine frühzeitig einsetzende kardiopulmonale Reanimation den SUDEP verhindern. In dieser Übersichtsarbeit werden wichtige Erkenntnisse zusammengefasst, neue Forschungsansätze kritisch diskutiert und ein für den klinischen Alltag relevantes Fazit gezogen.

Abstract

Sudden unexpected death in epilepsy (SUDEP) is a frequent cause of premature death in people with epilepsy. Most SUDEP cases occur at night and are often unobserved, so that its underlying pathomechanisms are not fully understood. Most SUDEP cases, however, are most likely a fatal complication of epileptic seizures. According to recent studies, SUDEP is caused by a suppression of cardiorespiratory activity in the early phase following generalized tonic-clonic seizures that finally leads to death. Several factors appear to increase the risk of SUDEP; for instance, young male epilepsy patients with uncontrolled generalized tonic-clonic seizures die more frequently from SUDEP than other patients. Recent research aims at identifying genetic causes as well as structural and functional cerebral dysfunction, which may enable the future development of biomarkers for increased SUDEP risk. So far, effective anticonvulsive drug therapy is the only evidence-based preventive measure. Nocturnal supervision of people with epilepsy may reduce the risk of SUDEP, and early cardiopulmonary resuscitation may also prevent SUDEP. This review summarizes important facts, critically discusses new findings in SUDEP research and draws conclusions that are relevant for the daily clinical practice.

Schlüsselwörter

plötzlicher Tod bei Epilepsie - Biomarker - Mortalität - SUDEP - Epilepsie

Keywords

sudden death in epilepsy - SUDEP - biomarker - epilepsy - mortality

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