Buchanan GF. Impaired CO(2)-Induced Arousal in SIDS and
SUDEP. Trends Neurosci. 2019 Mar 8. pii: S0166-2236(19)30018-9. doi:10.1016/j.tins.2019.02.002. [Epub ahead of print]
Abstract
Premature, sudden death is devastating. Certain patient
populations are at greater risk to succumb to sudden death. For instance,
infants under 1year of age are at risk for sudden infant death syndrome (SIDS),
and patients with epilepsy are at risk for sudden unexpected death in epilepsy
(SUDEP). Deaths are attributed to these syndromic entities in these select
populations when other diagnoses have been excluded. There are a number of
similarities between these syndromes, and the commonalities suggest that the
two syndromes may share certain etiological features. One such feature may be
deficiency of arousal to CO2. Under normal conditions, CO2 is a potent arousal
stimulus. Circumstances surrounding SIDS and SUDEP deaths often facilitate CO2
elevation, and faulty CO2 arousal mechanisms could, at least in part,
contribute to death.
_______________________________________________________________________
Every parent’s worst fear is not being able to keep their
child safe. And a mysterious condition known as sudden infant death syndrome
(SIDS) is enough to keep any new parent awake at night.
What’s so troubling about SIDS is that no one really
understands why a seemingly healthy baby goes to sleep and never wakes up. But
a new opinion review paper suggests that SIDS and other forms of sudden death
syndromes — which impact people of all ages and seem to strike without warning
or cause — may share a common, neurological cause.
Some individuals may be prone to sudden death syndromes
because they are born with a neurological difference that can be fatal under
the right circumstances, explains Gordon Buchanan, a neurologist and
epileptologist at the University of Iowa who authored the opinion review paper
in Trends in Neurosciences. Among these people, there seems to be a problem
with the part of the brain that controls breathing and waking during sleep…
Buchanan thinks that individuals who succumb to sudden death
syndromes may have malfunctioning serotonin receptors in their brains. These
receptors are part of our brain’s “suffocation alarm system” and help to ensure
that blood oxygen and carbon dioxide (CO2) levels are healthy. But Buchanan
thinks that a rare neurological difference causes some people’s brains to be
bad at detecting when blood CO2 levels get too high — which is a signal to our
bodies that we could be suffocating. Instead of waking up like most people
would, those with this defect stay asleep and are seemingly powerless against
what’s happening to them…
“The possibility that SIDS and SUDEP lie on a sudden death
continuum of sorts has been known in the SUDEP community for some time … using
known mechanisms for SIDS as a starting point for understanding SUDEP seemed
like a good place to start,” he said. “Defects in the brain stem serotonin
system have been identified in the brains of several cohorts of babies that
have dies of SIDS. Similar anatomical defects are starting to be identified in
pathological and imaging studies of people who have died of SUDEP.”…
Researchers have made some recent progress in understanding
what causes complex syndromes like SIDS. Last year, a team of researchers found
a genetic mutation affecting respiratory muscle function was associated with a
subset of SIDS cases. Another recent study found that smoking just one
cigarette per day during pregnancy can double a baby’s risk of SIDS. But more
research is needed to paint a more precise picture of what’s behind these
bewildering cases and how to test for them.
For now, Buchanan recommends that at-risk populations, like
people with epilepsy and parents of infants, follow preventive measures against
sudden death. Parents should place the babies on their backs to sleep and take
care to reduce plush toys, pillows, blankets, and loose-fitting clothing in the
crib. People with epilepsy can also take precautions, such as ensuring their
condition is properly managed, sleeping on their back, and using a seizure
alarm or monitor to alert family or neighbors if they have a seizure at night.
Courtesy of Doximity
No comments:
Post a Comment