Left-insular damage, autonomic instability, and sudden

Epilepsy & behavior : E&B · Feb 2016

Case Reports

Left-insular damage, autonomic instability, and sudden unexpected death in epilepsy.

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. ⋯ 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.

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- Nuria Lacuey, Bilal Zonjy, Wanchat Theerannaew, Kenneth A Loparo, Curtis Tatsuoka, Jayakumar Sahadevan, and Samden D Lhatoo.
- Epilepsy Center, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Department of Neurology, Vall d'Hebron University Hospital, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain; Department of Medicine, Universitat Autonoma of Barcelona, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: nuria.lacuey@uhhospitals.org.
- Epilepsy Behav. 2016 Feb 1; 55: 170-3.
AbstractWe 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. Copyright © 2015 Elsevier Inc. All rights reserved.

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Left-insular damage, autonomic instability, and sudden unexpected death in epilepsy.

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