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Abstract
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Research on sudden unexpected death (SUD) is essential to clinical and forensic medicine. The diagnosis of the cause of SUD is challenging and is a research hotspot in forensic medicine, especially in cases without specific diagnostic indicators and deaths from non-natural causes, including SUD in epilepsy (SUDEP). Further, the accurate diagnosis of the cause and manner of SUD is necessary for judicial purposes to ascertain facts, settle disputes, and resolve conflicts, particularly in confined places such as prisons, detention centers, and rehabilitation centers, and in cases of SUD of healthy middle-aged and young adults.
SUDEP was defined in 2012 as a category of death and is classified into seven subtypes: [1] definite SUDEP, characterized by a sudden, unexpected, witnessed or unwitnessed, non-traumatic, and non-drowning death, occurring in benign circumstances in individuals with epilepsy with or without evidence of seizures and excluding documented status epilepticus (seizure duration longer than 30 min or seizures without recovery), in which postmortem examination does not reveal a definite cause of death, [2] definite SUDEP plus, [3] probable SUDEP/probable SUDEP plus, [4] possible SUDEP, [5] near-SUDEP/near-SUDEP plus, [6] non-SUDEP, and [7] unclassified (1). SUDEP is diagnosed by excluding other causes that may have led to death. Diagnosis is controversial because of the lack of specific forensic markers and the tendency to occur more frequently among young people (2), as demonstrated in the present study. Mechanisms underlying SUDEP are incompletely understood but may be associated with seizure-related cardiac dysfunction, respiratory depression, autonomic nervous dysfunction, and brain dysfunction in the postictal phase (3).
This study focuses on the characteristics of SUDEP, underlying molecular mechanisms, and predictors of SUD with negative autopsy. The study evaluated seven original research articles and two reviews, including six studies from China, two from Canada, and one from Italy. |