During review of an un-anticipated death of a 45-year old man in our hospital in 2015 I had come across the term SUDEP.
This was the story of a businessman who had had epilepsy for several years and been on irregular treatment with his anti-epileptic medications, resulting in recent epileptic fit s. His seizures had been controlled in the emergency, but had been advised precautionary admission for a day.
He was last seen smiling and chatting with his wife, somewhat resentful about having to spend a day in hospital. A few hours later, while under close monitoring, his heart suddenly stopped and despite resuscitation, he died.
A similar story unfolded last month when a 19-year old boy had a similar unexpected outcome. His epilepsy had appeared to be under good control with all tests such as EEG and video monitoring showing negative results. And then, when he suddenly had a seizure and cardiac arrest, he could not be revived.
SUDEP is the acronym for Sudden Unexpected Death in Epileptic Patients, and seems to occur in one of every 1000 people suffering from epilepsy claiming over 100,000 lives every year. That is indeed a rather high figure given that epilepsy affects more than 1% of the population, amounting to over 1 crore in India itself.
The cause of SUDEP has intrigued neurologists and cardiologists for long. The person found dead often does not show signs of a recent seizure, such as tongue bite or urination suggesting that the cause could have been an irregular heart rhythm. Bursts of irregular electrical activity in the brain seems to find its way to the heart via the Vagus nerve. In the above patient who died in our hospital, that is what the cardiac monitor actually showed: the heart jerked irregularly and came to a sudden stop!
Epilepsy, a condition characterised by recurrent seizures without any obvious underlying disease, presents with episodic unexpected loss of consciousness usually with abnormal body movements. There are 6 types descibed: tonic-clonic, tonic, clonic, myoclonic, absence or atonic.
Fortunately, there are now several effective medications available to prevent seizure activities, but the patient has to be counselled well to take them regularly without missing a single dose.
Epilepsy is indeed common and has afflicted even great men such as Alexander, Julius Caesar and Napoleon who were said to have suffered from the “falling sickness”. In more recent times celebs such as Edgar Allan Poe, Lewis Carol (writers), Theodore Roosevelt ( President of USA) , Elton John (singer) and several others are on the list, indicating that it does not come much in the way of achievement and longevity in most.
Missing doses of medications can however endanger life of the patient or those around him. Two months ago when I was rushing to the airport to catch a night flight, the driver of my car suddenly suffered a seizure, his stiffened body and legs being on the brake, bringing the car to a jerky halt. I was left wondering what could have happened had his leg been on the other pedal!
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