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OBJECTIVE The primary objective of present study was to observe the effect of providing SUDEP (Sudden Unexpected Death in Epilepsy) information on drug adherence in persons with epilepsy (PWE). We also looked at impact of disclosing SUDEP information on patient's quality of life and mood. MATERIAL AND METHODS This prospective study had a pretest/post-test design. A total of 231 consecutive PWE (>15 years) were enrolled. Of these 121 PWE received information about SUDEP in addition to standard epilepsy care. One hundred and ten PWE (control group) received routine standard epilepsy care but did not receive SUDEP information. Follow up assessment was done at 6 months. The primary outcome was a change in drug adherence (measured by Modified Morisky Medication Adherence Scale, MMAS) in PWE following disclosure of SUDEP information. RESULTS After 6 months, 116 PWE in the SUDEP information group and 106 in control group were available for follow up. A non-significant higher adherence was observed in the SUDEP information group as compared to the control group (Mean MMAS change 0.51 ± 1.66 vs 0.25 ± 1.26, P value = 0.194). No significant change was perceived in patient's anxiety and depression levels or quality of life in either group. CONCLUSION The present study suggests that providing information on SUDEP to PWE and their caregivers may increase drug adherence without adverse effect on quality of life or mood. Well-designed studies with high methodological quality are required to determine the precise effect size associated with disclosure of SUDEP information on drug adherence in PWE.

International audience; During legal proceedings following the unexpected death of an infant, the magistrate calls on an expert to clarify the causes of death and to decide on the course to be taken. A report was made following the death of a 7-month-old baby girl after recovery from cardiac arrest when investigations of the cause revealed a subdural hematoma (SDH). We discuss the interconnection of these two entities and their role in the lethal process. In this infant, two distinct lesions with medicolegal implications were simultaneously present: on the one hand histiocytoid cardiopathy, and on the other hand SDH, which could result from ill-treatment. The case of this infant reminds us that the role of the pediatrician is to report the suspicion, whereas the role of the medical expert is to inform the magistrate as to the reality of abuse and its implication in the lethal process.

ObjectiveTo determine the incidence of sudden unexpected death in epilepsy (SUDEP) in children in Ontario, Canada.MethodsCases of suspected pediatric SUDEP occurring between January 1, 2014, and December 31, 2015, in Ontario, Canada, were eligible for inclusion. Potential cases were identified through 3 sources: a national pediatrician surveillance program, child neurologist report, and screening of provincial forensic autopsies. Cases were classified as definite, definite plus, probable, possible, and near/near plus according to criteria described by Nashef et al. (Epilepsia 2012). Overall crude pediatric SUDEP incidence and the incidence of definite or probable pediatric SUDEP were calculated using estimates of the prevalence of pediatric epilepsy in Canada drawn from government survey data and the number of children living in Ontario. Capture-recapture analysis was used to estimate the number of missing cases and determine an adjusted definite/probable SUDEP incidence.ResultsSeventeen cases of pediatric SUDEP resulted in an overall incidence of 1.17 (95% confidence interval 0.68–1.88) per 1,000 pediatric epilepsy person-years. The definite/probable incidence, including definite (n = 11), definite plus (n = 2), or probable (n = 3) SUDEP cases, was 1.11 (0.63–1.79). Capture-recapture analysis indicated an estimated 21 (16–39) definite/probable SUDEP cases occurred during the study period, giving an adjusted incidence of definite/probable SUDEP of 1.45 (0.90–2.22) per 1,000 pediatric epilepsy person-years.ConclusionSUDEP may be more common in children than widely reported, with the incidence rate of definite/probable SUDEP in children being similar to rates reported in adults.

Root cause analysis is a tool that can be used when determining how and why a patient safety incident has occurred. Incidents that usually require a root cause analysis include the unexpected death of a patient, serious pressure ulcers, falls that result in injury, and some infections and medication errors. This article outlines the stages of the investigation process for undertaking a root cause analysis. REFLECTIVE ACTIVITY: 'How to' articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of.

Background There is evidence that the sudden unexpected death in epilepsy (SUDEP) risk can be reduced by good seizure control, nocturnal supervision, and by early cardiopulmonary resuscitation if cardiorespiratory arrest occurs in the aftermaths of generalized tonic–clonic seizures (GTCS). These measures, however, may critically depend on the knowledge of patients and relatives on SUDEP. Here, we assessed the basic knowledge on SUDEP of people with epilepsy at a tertiary epilepsy center in Germany. Methods Adult patients with epilepsy and relatives or caregivers of patients with epilepsy aged 16 years or older attending our outpatient clinic from January to March 2014 were given the opportunity to participate in a (assisted or unassisted) written survey. In the anonymized questionnaire, people were asked if they had already heard about SUDEP, by what means and if they wish to learn (more) about SUDEP. Furthermore, age, sex, epilepsy duration, highest degree of education, number of GTCS during the last year, and estimation of subjective impairment by their disease were assessed. Statistics were done using mixed linear or logistic regression models. Results A total of 372 patients' questionnaires were included in this survey. More than 87% of the participants had never heard of SUDEP before. Whereas about 50% of the participants wanted to learn more about SUDEP, about 40% did not. Only the age at survey was significantly associated with both being informed and the desire of learning more about SUDEP: Younger patients had more often heard (p = 0.022) and wanted to know more about SUDEP (p = 0.020). Thirty-nine patients were considered at high risk for SUDEP. Of these, only 6 patients (15%) knew about SUDEP prior to this survey, but 18 patients (46%) wanted to learn more about this fatal complication. Conclusion Our data suggest that the level of information on SUDEP among people with epilepsy is poor in Germany regardless of sex, school education, or epilepsy severity. Additionally, a considerable proportion of people with epilepsy seems to prefer not getting detailed information on SUDEP. More efforts are required to understand the potential barriers of the education of patients and relatives on sudden death with the ultimate goal of decreasing the risk of SUDEP.

Awareness and research on epilepsy-related deaths (ERD), in particular Sudden Unexpected Death in Epilepsy (SUDEP), have exponentially increased over the last two decades. Most publications have focused on guidelines that inform clinicians dealing with these deaths, educating patients, potential risk factors and mechanisms. There is a relative paucity of information available for pathologists who conduct these autopsies regarding appropriate post mortem practice and investigations. As we move from recognizing SUDEP as the most common form of ERD toward in-depth investigations into its causes and prevention, health professionals involved with these autopsies and post mortem procedure must remain fully informed. Systematizing a more comprehensive and consistent practice of examining these cases will facilitate (i) more precise determination of cause of death, (ii) identification of SUDEP for improved epidemiological surveillance (the first step for an intervention study), and (iii) biobanking and cell-based research. This article reviews how pathologists and healthcare professionals have approached ERD, current practices, logistical problems and areas to improve and harmonize. The main neuropathology, cardiac and genetic findings in SUDEP are outlined, providing a framework for best practices, integration of clinical, pathological and molecular genetic investigations in SUDEP, and ultimately prevention.

Any unexpected death of a child should be properly investigated to determine whether the death was natural or violent (accident or homicide). This chapter provides information on infanticide, on sudden unexpected infant death and shaking, and on infant and small child homicide by means others than shaking.

Sudden unexpected death in epilepsy is a recurring calamity, yet there is little evidence to guide standards of care for supporting the bereaved. Grief in bereavement includes loss, feelings of guilt, anger and blame. There is also the shock and trauma of the sudden event. How can this be alleviated? This paper focuses on guiding the physician to support the bereaved, while recognising the limited evidence and the varying circumstances that may not always facilitate this. We propose a pathway of care and mode of communication with the deceased's family, with whom contact is currently limited. We suggest timely contact by telephone or in person, followed by ongoing support and referral to voluntary organisations and specialist services, as needed. Clarification and discussion may mitigate inappropriate feelings of guilt and blame, and may help the family with their sudden and unexpected loss.

Sudden cardiac death (SCD) describes a natural and unexpected death from cardiac causes occurring within a short period of time (generally within 1 h of symptom onset) in the absence of any other potentially lethal condition. Most SCD-related diseases have a genetic basis; in particular congenital cardiac channelopathies and cardiomyopathies have been described as leading causes of SCD. Congenital cardiac channelopathies are primary electric disorders caused by mutations affecting genes encoding cardiac ion channels or associated proteins, whereas cardiomyopathies are related to mutations in genes encoding several categories of proteins, including those of sarcomeres, desmosomes, the cytoskeleton, and the nuclear envelope. The purpose of this review is to provide a general overview of the main genetic variants that have been linked to the major congenital cardiac channelopathies and cardiomyopathies. Functional alterations of the related proteins are also described.

Background— Inherited arrhythmia syndromes are responsible for a significant portion of autopsy-negative sudden unexpected death (SUD) cases, but molecular autopsy used to identify potentially causal variants is not routinely included in SUD investigations. We collaborated with a medical examiner's office to assist in finding a diagnosis for their autopsy-negative child SUD cases. Methods and Results— 191 child SUD cases ( Conclusions— We have identified variants that may assist in the diagnosis of at least 6.3% of autopsy-negative child SUD cases and reduce risk of future SUD in surviving relatives. We recommend a cautious approach to variant interpretation. We also suggest inclusion of cardiomyopathy genes as well as other candidate SUD genes in molecular autopsy analyses.

Epileptic seizures are characterized by the excessive and abrupt electrical discharge in the brain. This asynchronous firing of neurons causes unprovoked convulsions which can be a cause of sudden unexpected death in epilepsy (SUDEP). Remote monitoring of epileptic patients can help prevent SUDEP. Systems based on wearable accelerometer sensors have shown to be effective in ambulatory monitoring of epileptic patients. However, these systems have a trade-off between seizure duration and the false alarm rate (FAR). The FAR of the system decreases as we increase the seizure duration. Further, multiple sensors are used in conjugation to improve the overall performance of the detection system. In this study, we propose a system based on single wrist-worn accelerometer sensor capable of detecting seizures with short duration (≥ 10s). Seizure detection was performed by employing machine learning approach such as kernelized support vector data description (SVDD). The proposed approach is validated on data collected from 12 patients, corresponding to approximately 966h of recording under video-telemetry unit. The algorithm resulted in a seizure detection sensitivity of 95.23% with a mean FAR of 0.72=24h.

Epilepsy is a group of neurological diseases characterized by epileptic seizures. It affects millions of people worldwide, with 80% of cases occurring in developing countries. This can result in accidents and sudden, unexpected death. Seizures can happen undetectably in newborns, comatose, or motor impaired patients, especially due to the fact that many medical personnel are not qualified for EEG signal analysis. Therefore, a portable automated detection and monitoring solution is in high demand. Thus, in this study a system of a wireless wearable adaptive for early prediction of epilepsy seizures, works via noninvasive wireless technology paired with an external control device (e.g., a doctors' smartphone), with a higher than standard accuracy (71%) and prediction time (14.56 sec) using artificial immunity system based detector. These novel architecture can save a life by helping to prevent a seizure's fatal consequences.

Introduction In 2013, 55,000 infants and children, aged 0 to 14, died in the United States. Nearly 7,000 of those deaths were attributed to traumatic causes. A child's death significantly affects emergency service personnel (ESP) caring for children and families. This study explores the lived experience of ESP involved in unsuccessful pediatric resuscitation efforts and how this experience affects them professionally and personally. Methods A phenomenologic approach guided this study. Using an open-ended format, an interview was conducted with a purposive sample of ESP who experienced unexpected pediatric death. Eight ESP participated in semistructured, face-to-face interviews, ranging in length from 35 to 75 minutes. The research question asked: "What is it like for you when a child dies after an unsuccessful resuscitation attempt?" Data were analyzed using thematic analysis. Results Van Manen's 4 existentials guided this study, and 10 subthemes emerged that included: "what if," "dying before my eyes," "team," "what if it was were my child?/being a parent," "the environment," "being trapped," "wounded healer," "education," "anger," and "coping." Discussion This study explores the experience of ESP involved in unsuccessful pediatric resuscitation that resulted in unexpected pediatric death and ESP's perceptions of this experience: thoughts of loss, a sense of anger, and a lack of preparation to cope with unexpected pediatric death and the unknowns of life.Image 1Contributions to Emergency Practice •The experience of dealing with unexpected pediatric death after unsuccessful resuscitations has a profound effect on emergency health care providers, personally and professionally. •There is a pressing need for continuing ongoing education on pediatric end-of-life issues. •Follow-up services would help with the grief emergency health care providers experience after the unexpected death of a child.

Importance Children with benign epilepsy with centrotemporal spikes (BECTS) have traditionally been considered to have a uniformly good prognosis. However, benign may be a misnomer because BECTS is linked to cognitive deficits, a more severe phenotype with intractable seizures, and the potential for sudden unexpected death in epilepsy (SUDEP). Objective To determine if cases of BECTS are present in the North American SUDEP Registry (NASR). Design, Setting, and Participants The NASR is a clinical and biospecimen repository established in 2011 to promote SUDEP research. The NASR database, which includes medical records, results of electroencephalographic tests, and interviews with family members of patients with epilepsy who died suddenly without other identifiable causes of death, was queried from June 3, 2011, to June 3, 2016, for cases of BECTS. The patients with epilepsy had died suddenly without other identifiable causes of death (eg, drowning, trauma, exposure to toxic substances, or suicide); SUDEP classification was determined by the consensus of 2 epileptologists. Main Outcomes and Measures Cases of SUDEP among children who received a diagnosis of BECTS among patients reported in the NASR. Results Three boys (median age at death, 12 years; range, 9-13 years) who received a diagnosis of BECTS by their pediatric epileptologist or neurologists were identified among 189 cases reported in the NASR. The median age of epilepsy onset was 5 years (range, 3-11 years), and the median duration of epilepsy was 4 years (range, 1-10 years). Two deaths were definite SUDEP, and 1 was probable SUDEP. Independent review of clinical and electroencephalographic data supported the diagnosis of BECTS in all 3 patients. None of the patients was prescribed antiseizure drugs, either owing to physician recommendation or mutual decision by the physician and parents. All 3 patients were found dead in circumstances typical of SUDEP. The 3 patients spanned the spectrum of BECTS severity: 1 had only a few seizures, 1 had more than 30 focal motor seizures, and 1 had 4 witnessed generalized tonic-clonic seizures and approximately 30 suspected generalized tonic-clonic seizures. Conclusions and Relevance Sudden unexpected death in epilepsy is a very rare outcome in BECTS that clinicians should consider discussing in appropriate circumstances and possibly factoring into treatment decisions.

Tandem mass screening has recently been started in Japan, but genetic screening has yet to be widely performed in neonates and many unexpected deaths are still being reported. We previously reported two cases of sudden infant death that may have been prevented had newborn screening been performed. In this study, we retrospectively reviewed 71 cases of sudden infant death for 66 arrhythmia- and 63 metabolic disease-related genes to identify how many cases of sudden infant death may have been prevented had mass screening been performed. Next-generation sequencing revealed that six cases had arrhythmia-related gene variants and five cases had metabolic disease-related gene variants. Had genetic screening been performed in addition to biochemical and physiological screening during the neonatal period to identify those at risk of arrhythmia or metabolic disease, these infants could have been diagnosed and treated, preventing their deaths. As such, screening of newborns may prevent sudden infant death.

The identification of a biomarker for sudden unexpected death in epilepsy (SUDEP) has the potential to save lives. Generalized convulsive seizures and postictal generalized suppression on electroencephalography (EEG) most often precede sudden unexpected death in epilepsy (SUDEP) and are potential biomarkers. We identify the EEG and seizure characteristics associated with postictal generalized EEG suppression in children with epilepsy.Video EEGs were reviewed for seizure type, duration and semiology, and electrographic features. To identify predictors of postictal generalized EEG suppression, we identified 40 children with generalized convulsive seizures from a group of 399 patients who experienced an electroclinical seizure during video-EEG. Seventy-seven generalized convulsive seizures with and without postictal generalized EEG suppression were anayzed.Age of seizure onset was older in 19 children with postictal generalized EEG suppression (mean 6.8 years old, 95% CI [4.7-8.9]) than in 21 without postictal generalized EEG suppression (3.0 years old, [1.1-4.1], P = 0.041). Postictal generalized EEG suppression occurred significantly more often from sleep than awake (point of estimate 16.67; 95% CI [0.97-32.36], P 0.038). Shorter duration of the clonic phase (-0.76; [-1.338, -0.133], P = 0.018) was significantly associated with postictal generalized EEG suppression. Ictal symmetric tonic extension posturing significantly increased the odds of postictal generalized EEG suppression (42.94; [18.77, 67.12], P = 0.001). All 15 generalized convulsive seizures with a terminal burst-suppression pattern were followed by postictal generalized EEG suppression in contrast to 19 of 62 generalized convulsive seizures without burst-suppression (15.32, P 0.001).Ictal decerebrate-like symmetric tonic extension posturing with shorter clonic phase and a terminal burst-suppression pattern identify malignant generalized convulsive seizures, associated with postictal generalized EEG suppression and a potentially increased risk of sudden unexpected death in epilepsy.

Suicide is a catastrophic event to both families and communities yet it is potentially preventable. This study aims to determine incidence and patterns of suicide in children and young adolescents in our region, raise awareness of this entity as a potentially preventable cause of death in this age group, and identify its possible associated risk factors. We retrospectively reviewed suicide cases presenting as sudden unexpected death in children and adolescents that underwent coronial post-mortems at our institution. This is the largest pathological review of completed suicide in children and young adolescents within a single institution in the United Kingdom. We identified 23 suicide cases during a 12 year period from 2003 to 2015, in which 18 cases (78%) were male and 5 cases (22%) were female. The age range was from 8 to 16 years (mean age 12.82 +/- 2.52 SD). With the exception of one case, all of the victims were Caucasian. The majority, 19 cases (81%), were found dead inside their place of residence, 15 of whom were discovered in their own bedrooms. Twenty-one cases (91%) died from neck compression due to hanging; 6 cases (26%) had used the cord of a dressing gown and 5 (22%) opted to use a belt as the ligature. Two cases (9%) that died from multiple-drug toxicity were female. In 7 cases (30.5%) there was evidence of self-harm and in 3 cases (13%) there was a history of previous suicide attempts. Petechial hemorrhages were found at autopsy in more than half of hanging victims and only three cases (14%) displayed dual distribution of post-mortem hypostasis (back and legs). Seven victims (30.5%) left some form of suicide message to family members and friends, 2 of which wrote the message on their arm. Parental separation, conflict with parents, and depression, were common amongst decedents prior to committing suicide. Substance abuse was uncommon in suicide within our cases. Valuable information is available from thorough review of suicide data in children and young adolescents from a single institution. Pathologists and clinicians can play crucial roles in identifying potential risk factors that may contribute to prevent future deaths.

Sudden unexpected death in epilepsy (SUDEP) is a major cause of premature death related to epilepsy. The causes of SUDEP remain unknown, but cardiac arrhythmias and asphyxia have been suggested as a major mechanism of this event. Inflammation has been implicated in the pathogenesis of both epilepsy and ventricular arrhythmia, with interleukin-6 (IL-6) being recognized as a crucial orchestrator of inflammatory states. Our group previously reported that levels of IL-6 were increased in the hearts of epileptic rats. In this scenario, anti-inflammatory actions are among the beneficial effects of fish oil dietary supplementation. This investigation revealed that elevated levels of IL-6 in the heart were markedly reduced in epileptic rats that were treated in the long-term with fish oil, suggesting protective anti-inflammatory actions against dangerously high levels of IL-6. Based on these findings, our results suggest beneficial effects of long-term intake of fish oil in reducing the inflammation associated with chronic epilepsy.

OBJECTIVES: To compare an indigenous sleep device (wahakura) for infants at high risk for sudden unexpected death with a bassinet, for measures of infant sleep position, head covering, breastfeeding, bed-sharing, and maternal sleep and fatigue. METHODS: A total of 200 mainly Māori pregnant women were recruited from deprived areas of New Zealand. They were randomized to receive a bassinet or wahakura and asked to sleep the infant in this device from birth. Questionnaires at 1, 3, and 6 months and an overnight infrared video in the home at 1 month were completed. RESULTS: An intention-to-treat and an “as-used” analysis of questionnaires showed no group differences at 1, 3, and 6 months in infant-adult direct bed-sharing (7% vs 12%, P = .24 at 1 month), and at the 6-month interview, the wahakura group reported twice the level of full breastfeeding (22.5% vs 10.7%, P = .04). Maternal sleep and fatigue were not significantly different between groups. Video identified no increase in head covering, prone/side sleep position, or bed-sharing in the wahakura group, either from intention-to-treat analysis, or when analyzed for actual sleep location. CONCLUSION There were no significant differences in infant risk behaviors in wahakura compared with bassinets and there were other advantages, including an increase in sustained breastfeeding. This suggests wahakura are relatively safe and can be promoted as an alternative to infant-adult bed-sharing. Policies that encourage utilization are likely to be helpful in high-risk populations.

Since the findings of a Fatal Accident Inquiry (FAI) in 2010, clinicians working in Scotland have been advised to discuss the risk of Sudden Unexpected Death in Epilepsy (SUDEP) with patients immediately or soon after a diagnosis of epilepsy is made. A thematic analysis was used to describe the experiences discussing SUDEP of 10 clinicians (six Consultant Neurologists and four Neurology Registrars) working in Scotland. Contrary to previous research, clinicians appear to be routinely discussing SUDEP in a standardized fashion with newly diagnosed patients and the FAI appears to have instigated this change in practice. Clinicians are ambivalent about the practice and whether this is a Breaking Bad News (BBN) experience. Clinicians appear to anticipate that patients will be anxious or distressed discussing SUDEP, despite their experiences that patients do not react this way. There are further concerns that the pressure to discuss SUDEP, as a result of the FAI, hinders effective communication of the SUDEP message. Implications for guideline development are discussed.

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in refractory epilepsy patients. Although specific mechanisms underlying SUDEP are not well understood, evidence suggests most SUDEP occurs due to seizure-induced respiratory arrest. SUDEP also tends to happen at night. Although this may be due to circumstances in which humans find themselves at night, such as being alone without supervision or sleeping prone, or to independent influences of sleep state, there are a number of reasons why the night (i.e., circadian influences) could be an independent risk factor for SUDEP. We explored this possibility. Adult male WT mice were instrumented for EEG, EMG, and EKG recording and subjected to maximal electroshock (MES) seizures during wakefulness, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep during the nighttime/dark phase. These data were compared with data collected following seizures induced during the daytime/light phase. Seizures induced during the nighttime were similar in severity and duration to those induced during the daytime; however, seizures induced during the nighttime were associated with a lesser degree of respiratory dysregulation and postictal EEG suppression. Seizures induced during REM sleep during the nighttime were universally fatal, as is seen when seizures are induced during REM during the daytime. Taken together, these data implicate a role for time of day in influencing the physiological consequences of seizures that may contribute to seizure-induced death.NEW & NOTEWORTHY Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. SUDEP frequently occurs during the night, which has been attributed to an effect of sleep. We have shown that sleep state does indeed influence survival following a seizure. That SUDEP occurs during the night could also implicate a circadian influence. In this study we found that time of day independently affects the physiological consequences of seizures.

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of epilepsy related mortality and animal models have collectively helped elucidate SUDEP causes and mechanisms. The chapter aims to serve as general resource and a summary of the current state of monitoring approaches commonly used in animals engineered or manipulated to model physiological processes relevant to SUDEP. One has to bear in mind that there are many variations of methods aimed at measuring and analyzing cortical, cardio-autonomic, and respiratory activities and the approach is typically driven by the research questions, type of animal model type, as well as by cost, availability or access to a specialized experimental set up.

• Evidence indicates that patients with mental illnesses have an increased incidence of sudden death.

Reflex seizures are triggered by external stimuli and occur in human epilepsy and many animal models. Human reflex seizures are commonly induced by visual stimuli, and most rodent reflex seizures are triggered by acoustic stimuli, which are termed audiogenic seizures (AGS). Prominent AGS models include DBA/1 and DBA/2 mice and genetically epilepsy-prone rats (GEPRs), which include GEPR-3s and GEPR-9s, that exhibit differing seizure severities. GEPRs are widely used to study neuronal networks of generalized seizures and anticonvulsant actions on neurons in this network. DBA mice are used in anticonvulsant screening studies and as models of sudden unexpected death in epilepsy (SUDEP). SUDEP preventative studies in DBA mice are investigating drugs that reduce the effect of adenosine or enhance the action of serotonin. Further work in these models is directed toward improved understanding of the neuronal mechanisms of epilepsy and SUDEP and developing better methods of prevention and treatment.

The space between the vocal cords and the mucosa covering them is the glottis. Glottic oedema can be caused by various reasons likehypersensitivity, inflammation, infection or by mechanical obstruction. Glottic oedema causes obstruction of air passages resulting inasphyxia and causes sudden unexpected death. Glottic oedema due to hypersensitivity or inhalation of smoke in cases of burn deathand endotracheal intubations will come across during autopsies. Glottic oedema by local infection resulting in death is rare. At Government Medical College, Thiruvananthapuram we had two such cases of death due to glottic oedema. In these cases glottic oedemaresulted from local infection at different sites.

Development of spontaneous seizures is the hallmark of human epilepsy. There is a critical need for new epilepsy models in order to elucidate mechanisms responsible for leading to the development of spontaneous seizures and for testing new anti-epileptic compounds. Moreover, rodent models of epilepsy have clearly demonstrated that there are two independent seizure systems in the brain: 1) the forebrain seizure network required for the expression of clonic seizures mediated by forebrain neurocircuitry, and 2) the brainstem seizure network necessary for the expression of brainstem or tonic seizures mediated by brainstem neurocircuitry. In seizure naïve animals, these two systems are separate, but developing models that can explore the intersection of the forebrain and brainstem seizure systems or for elucidating mechanisms responsible for bringing these two seizure systems together may aid in our understanding of: 1) how seizures can become more complex overtime, and 2) sudden unexpected death in epilepsy (SUDEP) since propagation of seizure discharge from the forebrain seizure system to the brainstem seizure system may have an important role in SUDEP because many cardiorespiratory systems are localized in the brainstem. The repeated flurothyl seizure model of epileptogenesis, as described here, may aid in providing insight into these important epilepsy issues in addition to understanding how spontaneous seizures develop.

International audience; This pioneering study in sub-Saharan African context examined the role played by religious strategies (religious coping, religious community support (RCS)) in the conjugal bereavement process and its outcomes depending on the expected or unexpected death. Based on cross-sectional approach, the study targeted Togolese bereaved spouses (N=162). The mean period of mourning was 112.52 months (SD=94.72). The results of a hierarchical regression revealed that RCS was positively associated with grief symptoms when the death was expected and, unsurprisingly, the negative religious coping predicted grief symptoms when the death was sudden and unexpected. Religious strategies would play a threefold role: providing refuge and comfort, regulating the bereavement distress and serving resources to give meaning to the loss of the beloved. Theoretical and clinical implications of these findings are discussed.

Contains fulltext : 173021.pdf (Publisher’s version ) (Open Access) Placement of catheters, drains, shunts, and tubes in children can lead to serious or even fatal complications at the moment of placement, such as hemorrhage at insertion, or in the longterm, such as infections and migration into adjacent organs. The clinician should always be aware of these potential complications, especially if the child is unwell. For postmortem diagnostic evaluation, either with a computed tomography scan or an invasive autopsy, all tubes, drains, shunts, and/or catheters should be left in situ. We present three cases with fatal complications after the placement of a chest drain, ventriculoperitoneal shunt, and gastrostomy tube.

Sudden Infant Death Syndrome (SIDS) is associated with the sudden and unexpected death of a child under the age of one who is apparently healthy. This unforeseen death, in most cases has no explanation. Although its causes are not known with certainty, we do know of the risks that can trigger them. This work presents a network of sensors to monitor the main risk factors in this pathology, such as: temperature, humidity or the level of gases in the environment. A non-invasive system is proposed since the sensors are not in direct contact with the infant, unlike most monitoring systems available today. In particular, a virtual organization of agents has been developed, it is capable of integrating different sensors on an open and low cost hardware platform.

Epilepsy is associated with an increased risk of death, 2–3 greater than in the general population. This excess is mainly related to associated or underlying disease that has caused epilepsy (structural lesions, infections, tumours), accidents and drowning because of seizures, and convulsive status epilepticus. Sudden unexpected death in epilepsy (SUDEP) is a less common reason for the increased mortality in epilepsy and may be the result of the direct effect of an epileptic (usually convulsive) seizure on the cardiorespiratory (heart and lungs) system or the brain itself. Most cases of SUDEP involve young patients (from late teens to late forties) with a long history of tonic-clonic seizures. Frequently SUDEP occurs in sleep. In many patients antiepileptic drug levels are generally low.

Bakgrund: I Sverige dör cirka 90 000 personer varje år. Majoriteten av dessa är förväntade dödsfall relaterat till ålder och sjukdomar. Plötslig död innefattar mord, suicid, olycksfall eller akut sjukdom. I mötet med anhöriga efter plötslig död har sjuksköterskan till uppgift att delge stöd och information. Det finns många studier gjorda på hur anhöriga upplever bemötandet i vården men desto mindre forskning om hur sjuksköterskan upplever mötet med anhöriga vid plötslig död. Syfte: Att beskriva sjuksköterskans upplevelse av att möta anhöriga vid plötslig död på sjukhus. Metod: Kvalitativ intervjustudie där 10 sjuksköterskor, från två olika avdelningar från ett sjukhus i södra delen av Sverige, har intervjuats. Intervjuerna bearbetades och har analyserats genom en kvalitativ innehållsanalys. Resultat: Studien resulterade i tre huvudkategorier; Kräver professionalitet, Anhörigas reaktioner påverkar och Behöver vara personlig. Slutsats: Hur sjuksköterskan möter och bemöter anhöriga är ett viktigt moment i vården och för den familjecentrerade omvårdnaden. Sjuksköterskor som påträffar plötsliga dödsfall i sitt yrke upplever att det är komplext att möta anhöriga vid dessa situationer. Background: Approximately 90 000 people die each year in hospitals throughout Sweden. The majority of these are expected deaths related to age and disease. The causes of sudden death include homicide, suicide, accidental or acute illness. When this occurs, nurses are responsible for sharing support and information with the relatives. There have been many studies conducted on the experience of family members and the treatment they receive in hospitals. However, there is less research present on the experiences of nurses when meeting families after sudden death. Aims: To describe nurses' experience of meeting relatives, when sudden death occurs in a hospital. Method: Qualitative interview study where a total of 10 nurses participated in the interviews, from two different departments of a hospital, in southern Sweden. The interviews were analyzed using a qualitative content analysis. Results: The study resulted in three main categories; Require professionalism, Relatives` reactions effects and Need to be personal. Conclusion: How the nurse meets and treats families is an important part of the care and the family-centered care. Nurses who encounters sudden death in the professional experience that it is complex to meet relatives after sudden death.

This discusses how pharmacological modulation of the Ca2+/cAMP signaling interaction could be an important neuroprotective and cardioprotective strategy to protect the dopaminergic neurons from cell death related to Parkinson’s disease (PD) and at the same time to prevent the cardiac collapse in sudden unexpected death in PD.

Public commemoration of unexpected death in America, while often focused on charismatic celebrities in the short term, typically finds permanent form...

Working hypothesis: benign febrile seizures seen in 7% of infants before 6 months play a role in the terminal pathway in a subset of sudden infant death syndrome victims. Supporting evidence: (1) lack of 5-hydroxitryptamine, one consistent finding in sudden infant death syndrome that Kinney et al coined a developmental serotonopathy, is consistent with risk for seizures. (2) Non–rapid eye movement sleep increasing during the age of highest risk for sudden infant death syndrome facilitates some seizures (seizure gate). (3) Sudden unexpected death in epilepsy is associated with severe hypoxemia and hypercapnia during postictal generalized electroencephalographic (EEG) suppression. In toddlers, sudden unexplained deaths are associated with hippocampal abnormalities and some seizures. (4) The sudden nature of both deaths warrants an exploration of similarities in the terminal pathway. Moreover, sudden infant death syndrome, febrile seizures, sudden unexplained death in childhood, and sudden unexpected death in epilepsy share some of the following risk factors: prone sleeping, infections, hyperthermia, preterm birth, male gender, maternal smoking, and mutations in genes that regulate sodium channels. State-of-the-art molecular studies can be exploited to test this hypothesis.

Worldwide, mortality associated with epilepsy is a matter of grave concern. The mortality rate in epileptic population is two to three times more than that of the general population. Sudden unexplained death in epilepsy, better known as sudden unexpected death in epilepsy (SUDEP), is a mysterious and rare condition, in which typically young or middle-aged people with epilepsy die without a clearly defined cause. At times, this may raise a strong suspicion of foul play and raise several medico-legal issues. There may be several different underlying mechanisms but most research has focused on seizure-related cerebral and respiratory depression, cardiac arrhythmia and autonomic dysfunction. In recent years, some significant risk factors have been recognized and strategies have been suggested that could be useful in prevention of SUDEP. Present communication provides some of the updates on new advances in prevention of SUDEP as well as highlights related medico-legal issues.

In this article the author draws on personal experiences, amongst them the sudden, unexpected death of her own son, to explore the challenges and benefits of creating memorials and mementoes following a significant death. The article supports existing work which argues for the importance of mementoes in creating meaning, particularly in a culture where death is still largely sequestered from public discourse. The author uses examples from her own son’s death, combined with the experiences of parents in her research study, exploring professional intervention following sudden, unexpected child death. These examples demonstrate that parents may require extremely pragmatic support, for example advice on how to scatter ashes and whether to establish memorials in perpetuity. The article concludes that the prevailing culture of concealment around death could be challenged by a targeted programme of death education, which includes practical advice on creating enduring memorials and mementoes.

Background This review examines the factors that can influence an investigation into the unexpected death of a child before considering if using imaging techniques could be of benefit. Method A systematic search strategy was adopted to search databases using keywords, these results were then subjected to inclusion and exclusion criteria to filter and refine the evidence base further. Discussion More research is published on the use of MRI in comparison with other modalities. There is evidence in the case of MRI in particular that its use could be of benefit in identifying and ruling out potential causes of death in children. Conclusion More research is needed on the use of CT but the routine use of MRI in child death investigation could now be considered. Ethical considerations appear to be a barrier to research in this area and discussions as to how such considerations can be overcome is necessary.

SummaryBackgroundThe burden of sudden unexplained death in sub-Saharan Africa is unknown.AimThe aim of this study is to establish the epidemiology of sudden cardiac death in Cameroon.MethodsThe Douala sudden unexplained death (Douala-SUD) study is a prospective, multiple-source, community-based surveillance of all cases of unexpected death (15 years. After approval from institutional boards, all deaths occurring in residents of four areas of Douala city will be checked for circumstances of death and past medical history. Subjects who die naturally will be further investigated. Unexpected death victims will be checked for detailed demographic, clinical, electrocardiographic, echocardiographic and biological records. Autopsy background and genetic analysis (postmortem or in first relatives if the young victim is aged