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Chew on this: Sardines are still a healthy choice against SUDEP

2014; Elsevier BV; Volume: 41; Linguagem: Inglês

10.1016/j.yebeh.2014.08.019

1525-5069

Carla A. Scorza, Ésper A. Cavalheiro, Lineu Calderazzo, Antonio‐Carlos G. de Almeida, Fúlvio A. Scorza,

Neuroscience and Neuropharmacology Research

People with epilepsy are more likely to die prematurely than those without epilepsy, and sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in individuals with drug/treatment-refractory epilepsy [ 1 Massey C.A. Sowers L.P. Dlouhy B.J. Richerson G.B. Mechanisms of sudden unexpected death in epilepsy: the pathway to prevention. Nat Rev Neurol. 2014; 10: 271-282 Crossref PubMed Scopus (243) Google Scholar , 2 Nei M. Hays R. Sudden unexpected death in epilepsy. Curr Neurol Neurosci Rep. 2010; 10: 319-326 Crossref PubMed Scopus (74) Google Scholar , 3 Nashef L. Ryvlin P. Sudden unexpected death in epilepsy (SUDEP): update and reflections. Neurol Clin. 2009; 27: 1063-1074 Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar , 4 Duncan J.S. Sander J.W. Sisodiya S.M. Walker M.C. Adult epilepsy. Lancet. 2006; 367: 1087-1100 Abstract Full Text Full Text PDF PubMed Scopus (609) Google Scholar ]. From an epidemiological point of view, SUDEP is estimated to cause nearly 2000 deaths per year in the USA alone [ [5] Thurman D.J. The epidemiology of SUDEP: a public health perspective. Epilepsy Curr. 2013; : 9 PubMed Google Scholar ] and is responsible for 7.5% to 17% of all deaths in people with epilepsy and has an incidence among adults between 1:500 and 1:1000 patient-years [ [6] Schuele S.U. Widdess-Walsh P. Bermeo A. Lüders H.O. Sudden unexplained death in epilepsy: the role of the heart. Cleve Clin J Med. 2007; 74: S121-S127 Crossref PubMed Scopus (90) Google Scholar ]. Information concerning risk factors for SUDEP is conflicting, but the most consistent risk factor across multiple studies is an increased frequency of generalized tonic–clonic seizures (GTCS) [ [7] Hesdorffer D.C. Tomson T. Benn E. Sander J.W. Nilsson L. Langan Y. et al. Combined analysis of risk factors for SUDEP. Epilepsia. 2011; 52: 1150-1159 Crossref PubMed Scopus (329) Google Scholar ]. In parallel, other important risk factors include the following: young age at epilepsy onset, nocturnal seizures, seizure type, longer duration of epilepsy, number of antiepileptic drugs used, symptomatic etiology of epilepsy, male gender, alcohol abuse, and winter temperatures [ 8 Hesdorffer D.C. Tomson T. Sudden unexpected death in epilepsy: potential role of antiepileptic drugs. CNS Drugs. 2013; 27: 113-119 Crossref PubMed Scopus (74) Google Scholar , 9 Scorza F.A. de Albuquerque M. Arida R.M. Cavalheiro E.A. Sudden unexpected death in epilepsy: are winter temperatures a new potential risk factor?. Epilepsy Behav. 2007; 10: 509-510 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar , 10 Scorza F.A. Terra V.C. Arida R.M. Scorza C.A. Cavalheiro E.A. Sudden unexpected death in epilepsy and winter temperatures: it's important to know that it's c-c-c-c-cold outside. Epilepsy Behav. 2009; 14: 707 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar ]. The cause or causes of SUDEP are still unknown, but the general consensus is that seizures somehow disrupt normal cardiac or respiratory physiology leading to fatal events [ 11 Nei M. Hays R. Sudden unexpected death in epilepsy. Curr Neurol Neurosci Rep. 2010; 10: 319-326 Crossref PubMed Scopus (55) Google Scholar , 12 Surges R. Thijs R.D. Tan H.L. Sander J.W. Sudden unexpected death in epilepsy: risk factors and potential pathomechanisms. Nat Rev Neurol. 2009; 5: 492-504 Crossref PubMed Scopus (334) Google Scholar , 13 Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol. 2008; 7: 1021-1031 Abstract Full Text Full Text PDF PubMed Scopus (508) Google Scholar , 14 Stollberger C. Finsterer J. Cardiorespiratory findings in sudden unexplained/unexpected death in epilepsy (SUDEP). Epilepsy Res. 2004; 59: 51-60 Abstract Full Text Full Text PDF PubMed Scopus (187) Google Scholar ]. Actually, it is generally agreed that SUDEP is mainly, but not exclusively, a problem for people with refractory epilepsy [ [13] Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol. 2008; 7: 1021-1031 Abstract Full Text Full Text PDF PubMed Scopus (508) Google Scholar ], but effective preventive strategies in high-risk patients are still not satisfactory [ [1] Massey C.A. Sowers L.P. Dlouhy B.J. Richerson G.B. Mechanisms of sudden unexpected death in epilepsy: the pathway to prevention. Nat Rev Neurol. 2014; 10: 271-282 Crossref PubMed Scopus (243) Google Scholar ]. In this sense, one of the goals of scientists against SUDEP occurrence is to develop new strategies to prevent it and actions other than medical and surgical therapies that could be very useful. From this perspective, epidemiologic and observational data seem to suggest some measures to minimize the risk of SUDEP, and these include good seizure control, stress reduction, participation in physical activity and sports (with appropriate professional supervision), night supervision, and family members' knowledge of cardiopulmonary resuscitation techniques, the basics of defibrillator use, and dietary management (n−3 fatty acid – omega-3 FA – supplementation) [ 13 Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol. 2008; 7: 1021-1031 Abstract Full Text Full Text PDF PubMed Scopus (508) Google Scholar , 15 Scorza F.A. Cysneiros R.M. Arida R.M. Terra V.C. Machado H.R. Rabello G.M. et al. Fish consumption, contaminants and sudden unexpected death in epilepsy: many more benefits than risks. Braz J Biol. 2010; 70: 665-670 Crossref PubMed Scopus (12) Google Scholar , 16 Scorza F.A. Arida R.M. Terra V.C. Cavalheiro E.A. What can be done to reduce the risk of SUDEP?. Epilepsy Behav. 2010; 18: 137-138 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar ].