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Yıl:2016; Cilt: 53; Sayı: 1>> Özet
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Nöropsikiyatri Arşivi; 2016;53(1):64-68
SUDEP: Türkiye’de İlk Olgu Serisi
M Güngör, EA Arslan, FİT Filik, S Saygı
Hacettepe Üniversitesi, Ankara
Amaç: SUDEP (Sudden unexpected death of epilepsy); bir epilepsi hastasında boğulma, travma ve status epileptikus ekarte edildikten sonra; ani, beklenmedik, görgü tanığı olsun olmasın, ölüm sırasında nöbet kanıtı olsun olmasın meydana gelen ölümdür. Bu çalışmada, epilepsi kliniğinde takip edilirken ani ve beklenmedik ölüm nedeniyle kaybedilen hastalar derlenmiş ve ülkemizde SUDEP’in öneminin vurgulanması amaçlanmıştır. Yöntem: Toplam 9 vaka ile çalışma gerçekleştirilmiştir. Veriler, hastane kayıtları, hasta yakınlarının ifadeleri, T.C. İçişleri Bakanlığı Nüfus ve Vatandaşlık Hizmetleri Genel Müdürlüğü veri tabanı ve Büyükşehir Belediyesi Mezarlık Bilgi Sistemi veri tabanından elde edilmiştir. 2011’de Uluslararası Epilepsi Ligi (ILAE; International League Against Epilepsy) önderliğinde bir araya gelen L.Nashef ve arkadaşlarının, SUDEP için önerdiği sınıflandırma ve tanımlamalar temel alınmıştır. Bulgular: Olguların 8 tanesi muhtemel SUDEP, 1 tanesi ise olası SUDEP olarak sınıflandırılmıştır. Ortalama SUDEP yaşı 33; ortalama takip süresi 19,7 yıl olarak bulunmuştur. Olgularda, bilinen risk faktörleri dışında (jeneralize tonik klonik nöbet öyküsü, noktürnal nöbetler, şiddetli epilepsi, sık nöbetler, erken yaşta başlayan epilepsi, tanığı olmayan nöbetler, politerapi ve mental gerilik) farklı bir risk faktörüne rastlanmamıştır. Sonuç: Bu çalışma, SUDEP konusunda Türkiye’de sunulan ilk vaka serisidir. Çalışmanın en önemli eksiği postmortem çalışmalardır. Ancak eldeki veriler sunularak konunun önemi vurgulanmak istenmiştir. SUDEP; nörologların, pediatrik nörologların, adli tabiplerin ve aile hekimlerinin gündeminde daha fazla yer almayı hak etmektedir. Çünkü epilepsi tanısı olan ve vefat eden her birey, ölümün görünen nedenine bakılmaksızın, ani ve beklenmedik bir ölümse; SUDEP yönünden mutlaka değerlendirilmelidir.
SUDEP: The First Case Series in Turkey
Introduction: Sudden unexpected death in epilepsy (SUDEP) is defined as the sudden, unexpected, witnessed or unwitnessed, non-traumatic, and non-drowning death of patients with epilepsy with or without evidence of a seizure, excluding documented status epilepticus, and in whom postmortem examinations do not reveal a toxicological or anatomic cause for death. In this study, data on patients who passed away under observation in the epilepsy clinic due to sudden, unexpected death have been compiled, and we also aim to emphasize the importance of SUDEP in Turkey. Methods: This study was performed with a total of nine cases. Data were obtained from hospital records, information given by the families of patients, the database of the General Directorate for Civil Services of the Ministry of Internal Affairs of Turkey, and from the Ankara Metropolitan Municipality Cemetery Information System. As the basis of classification and definition, the proposals suggested by Nashef et al., which were made to the International League Against Epilepsy (ILAE) in 2011, were taken into consideration. Results: Eight of the patients were classified as probable SUDEP and one of them as possible SUDEP; the mean age at SUDEP was 33 years, and the average follow-up period was 19.7 years. In these cases, except for known risk factors (generalized tonic–clonic seizures, nocturnal seizures, severe epilepsy, more frequent seizures, younger age at the onset of epilepsy, unwitnessed seizures, polytherapy, and mental handicap), a different risk factor was not identified Conclusion: This study is the first case series on SUDEP in Turkey. Postmortem studies are the most important shortcoming of the study. However, the importance of the topic is highlighted by presenting the available data. SUDEP deserves more attention during the daily practice of neurologists, pediatric neurologists, forensic physicians, and family physicians. If death is sudden and unexpected in a patient with epilepsy, SUDEP should be considered, regardless of the clear causes of death.

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