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

Nuria Lacuey; Bilal Zonjy; Wanchat Theerannaew; Kenneth A Loparo; Curtis Tatsuoka; Jayakumar Sahadevan; Samden D Lhatoo

doi:10.1016/j.yebeh.2015.12.009

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

Epilepsy Behav. 2016 Feb:55:170-3. doi: 10.1016/j.yebeh.2015.12.009. Epub 2016 Feb 1.

Authors

Nuria Lacuey¹, Bilal Zonjy², Wanchat Theerannaew³, Kenneth A Loparo³, Curtis Tatsuoka³, Jayakumar Sahadevan⁴, Samden D Lhatoo⁵

Affiliations

¹ 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.
² Epilepsy Center, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
³ Department of Electrical Engineering and Computer Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
⁴ Department of Cardiology, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
⁵ Epilepsy Center, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; NINDS Center for SUDEP Research (CSR), USA.

Abstract

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. 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.

Keywords: Autonomic; Heart rate variability; Insula; Parasympathetic; Postictal bradycardia; SUDEP.

Publication types

Case Reports
Research Support, N.I.H., Extramural

MeSH terms

Adult
Autonomic Nervous System Diseases / complications*
Autonomic Nervous System Diseases / pathology
Autonomic Nervous System Diseases / physiopathology
Cerebral Cortex / pathology*
Cerebral Cortex / physiopathology
Death, Sudden / etiology*
Death, Sudden / pathology
Epilepsy / complications*
Epilepsy / pathology
Epilepsy / physiopathology
Heart Rate / physiology
Humans
Male
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding