Download MORTEMUS MORTality in Epilepsy Monitoring Unit Study

MORTEMUS
MORTality in Epilepsy Monitoring
Unit Study
USING IN-HOSPITAL PRE-SURGICAL MONITORING DATA TO ASSESS RISKS,
MECHANISMS AND RISK FACTORS OF SUDDEN UNEXPECTED DEATH IN
EPILEPSY (SUDEP)
Proposal for an ILAE sponsored European study
Philippe Ryvlin, Lyon
Torbjörn Tomson, Stockholm
Why Epilepsy Surgery Patients?
Population with highest risk
 Population/situation with most and best
data
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Why collaboration?
Because SUDEP is a rare event
 Broad collaboration is the only way to
collect sufficient numbers

MORTEMUS Objectives
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To quantify the risk of death, SUDEP, and “near SUDEP”,
in patients with drug resistant partial epilepsy who have
undergone long-term video-EEG monitoring
To gather up to 20 cases of SUDEP / “near SUDEP” for
whom concomitant video, EEG and EKG data will be
available
To provide evidence regarding the respective role of
cardiac vs. respiratory dysfunctions in the
pathophysiology of SUDEP
To identify risk factors for SUDEP in patients with
refractory epilepsy
Objectives continued

To evaluate the feasibility and rationale for launching a
large scale European prospective study that aims to
confirm the above retrospective data, and also to
determine whether heart rate variability parameters can
predict the risk of SUDEP
MORTEMUS Methods
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To establish a network of collaborating epilepsy surgery
centres in Europe, aiming at in total 3-4000 patient years
of monitoring during the past 10 years
Distribution of questionnaire regarding SUDEP or nearSUDEP cases during monitoring in these units
Centralised analysis of all data (EEG, ECG, video etc)
from SUDEP/near-SUDEP cases for a descriptive study
Case-control study of SUDEP/near-SUDEP cases vs.
Non-SUDEP epilepsy controls from the same monitoring
unit
SUDEP under Monitoring
”Cerebral Electrical Shutdown”
Reference
Age/sex Monitoring
Seizure EEG
Bird 1997
47/m
Video/Intra sGTCS
cranial
Flat EEG
Pulse
artifacts 2
min
Lee 1998
41/f
Video/scalp sGTCS
Electrocerebral
silence
bradycardia
So 2000
(nearSUDEP)
20/f
Video/scalp sGTCS
Apnea,
Initially
marked
unimpaired
suppresion
McLean
2007
50/f
Amb.EEG
Flat EEG
?
ECG
Asystole
after 57s