Forensic Analysis of 9 Cases of Sudden Unexpected Death in Epilepsy / 法医学杂志

OBJECTIVES@#To analyze the case, scene and forensic pathological characteristics of sudden unexpected death in epilepsy (SUDEP), to provide a practical basis for forensic identification.@*METHODS@#A total of 9 autopsy cases of SUDEP were collected. The basic information of the cases, the scene characteristics, the forensic pathological changes, the common drugs and antiepileptic drug test results, and pericardial fluid biochemical test results were analyzed.@*RESULTS@#All of the 9 cases were male epilepsy patients died during sleep at night, the age of death was (37.1±8.6) years, and the course of epilepsy was (21.3±5.6) years. Six corpses were in prone position and three in left lateral position. The hemorrhage of the sternocleidomastoid muscle, sternal thyroid muscle and sternohyoid muscle were found with 8 cases, 5 cases and 4 cases, respectively, all of them were unilateral. Six cases had bilateral hemorrhage of pectoralis minor muscle. Brain edema, phagocytosis of frontotemporal neurons and gliosis, cardiac fibers bend in wavy patterns and eosinophilic staining enhancement, pulmonary edema, pulmonary congestion, alveolar hemorrhage, pulmonary small bronchiole wall shrinking, tubular proteinuria and pancreatic parenchymal hemorrhage were the common histopathological changes. The biochemical test results of pericardial fluid indicated that there were myocardial ischemic damage.@*CONCLUSIONS@#Young male, early onset, long course of disease, sleep in the prone position, poor drug compliance or combination, epileptic seizure may be the risk factors of SUDEP. Cardiac dysfunction and respiratory depression might be the main death mechanism of SUDEP.

Autopsy findings of SUDEP in adolescence

@#Sudden unexpected death in epilepsy (SUDEP) is a rare in children; the risk of SUDEP in children is up to 10-fold less than adults. Herein, we report a case of SUDEP in a 14-year-old boy. The post-mortem findings in neuropathological examination in SUDEP are not pathognomonic. Tongue and lip bites marks are only an indication of a seizure before death. Basically, there are no lesions that could explain the incidence of seizures before death. However, post-mortem examination is mandatory in order to determine the diagnosis of SUDEP. Autopsy, histopathological, and toxicologic examinations and a proper medical history of epilepsy are required to come to diagnosis of SUDEP. This case report further demonstrates the importance of medicolegal autopsy in allegedly dead victims.

Muerte súbita e inesperada en la epilepsia (sudep) / Sudden unexpected death in epilepsy

El SUDEP se refiere a la muerte súbita e inesperada con o sin testigos, no traumática, y no por ahogamientos en un paciente epiléptico, con o sin evidencia de que haya sufrido una crisis epiléptica al morir, en el que se haya descartado un estado convulsivo como causa de muerte y en el que la autopsia no proporcione evidencia alguna de una causa anatómica o tóxica de la muerte. Aunque SUDEP ha sido reconocida desde el siglo XIX, sólo en las últimas dos décadas se le ha dado la importancia que ¨¦sta requiere. La frecuencia de SUDEP depende de la severidad de la epilepsia pero en general el riesgo de muerte súbita es de 20 veces mayor que el de la población en general. El edema pulmonar neurógeno, la apnea central y la arritmia cardiaca, inducidos por una descarga Á-adrenérgica de origen central, constituyen los tres mecanismos fisiopatogínicos más estrechamente relacionados con la SUDEP. Por lo anterior obliga al clínico a realizar una minuciosa autopsia la cual deber¨ªa incluir un examen neuropatol¨®gico que documente los cambios cerebrales que subyacen a la epilepsia, toxicología y el examen del corazón, los pulmones y otros órganos.

The SUDEP refers to the sudden and unexpected death with or without witnesses, non-traumatic, and not drowning in an epileptic patient, with or without evidence that he suffered a seizure at death, in which a state is ruled seizure as the cause of death in the autopsy did not provide evidence of a toxic or anatomic cause of death. Although SUDEP has been recognized since the nineteenth century, only in the last two decades has been given the importance it requires. SUDEP frequency depends on the severity of epilepsy but in general the risk of sudden death is 20 times higher than the general population. Neurogenic pulmonary edema, central apnea and cardiac arrhythmias induced by ¦Á-adrenergic shock of central origin, pathophysiologic mechanisms are the three most closely related to SUDEP. Therefore forcing the clinician to perform a thorough autopsy, which should include neuropathological examination to document brain changes that underlie epilepsy, toxicology and examination of the heart, lungs and other organs.

Muerte súbita e inesperada en la epilepsia (SUDEP) / Sudden unexpected death in epilepsy (SUDEP)

El SUDEP se refiere a la muerte súbita e inesperada con o sin testigos, no traumática, y no por ahogamientos en un paciente epiléptico, con o sin evidencia de que haya sufrido una crisis epiléptica al morir, en el que se haya descartado un estado convulsivo como causa de muerte y en el que la autopsia no proporcione evidencia alguna de una causa anatómica o tóxica de la muerte. Aunque SUDEP ha sido reconocido desde el siglo XIX, solo en las últimas dos décadas se le ha dado la importancia que ésta requiere. La frecuencia de SUDEP depende de la severidad de la epilepsia pero en general el riesgo de muerte súbita es de 20 veces mayor que el de la población en general. El edema pulmonar neurógeno, la apnea central y la arritmia cardiaca, inducidos por una descarga a-adrenérgica de origen central, constituyen los tres mecanismos fisiopatogénicos más estrechamente relacionados con la SUDEP. Por lo anterior obliga al clínico a realizar una minuciosa autopsia la cual debería incluir un examen neuropatológico que documente los cambios cerebrales que subyacen a la epilepsia, toxicología y el examen del corazón, los pulmones y otros órganos...