Jan E. Leestma

Bio: Jan E. Leestma is an academic researcher from Northwestern University. The author has contributed to research in topics: Sudden death & Epilepsy. The author has an hindex of 14, co-authored 36 publications receiving 1287 citations. Previous affiliations of Jan E. Leestma include Southern Illinois University Carbondale.

A prospective study on sudden unexpected death in epilepsy

Abstract: Sudden unexpected death accounts for a substantial portion of deaths among epileptics. The incidence of this phenomenon is probably 1 in 370 to 1 in 1,110 in the general epileptic population but may be even higher in the 20- to 40-year age group, and still higher if epileptics with symptomatic epilepsy are selected. Sudden unexpected death in epileptics has been observed at least once weekly by the Office of the Medical Examiner of Cook County (Chicago), Illinois, for many years. A year-long prospective study revealed that victims of this complication of epilepsy are most commonly black males averaging 35 years of age who have infrequent generalized seizures and usually have some structural lesion in the brain responsible for their seizures. They tend to abuse alcohol and have poor compliance with anticonvulsant medication. The electroencephalograms display considerable variability from record to record. At autopsy the heart, lung, and liver weights were heavier and the brain weights were lighter than expected. The mechanisms involved in sudden unexpected death in epileptics may include autonomically mediated cardiac arrhythmia alone or in combination with sudden "neurogenic" pulmonary edema and "backward" cardiac failure.

Sudden Unexplained Death in Epilepsy: Observations from a Large Clinical Development Program

Abstract: Summary: Purpose: The present study was conducted to determine the rate of sudden unexplained death in epilepsy (SUDEP) in a well-defined cohort of patients included in the lamotrigine (LTG) clinical development database. Methods: A panel of scientists experienced in the area of SUDEP was assembled and provided with case summaries on all deaths (n = 45) reported during the initial clinical development of LTG. The panel developed a set of criteria for classifying cases as SUDEP (definite or highly probable), possible SUDEP, or non-SUDEP. This classification algorithm was then applied to the LTG cases, and SUDEP rates were calculated using patient-years of exposure as the denominator. Results: At the time of the study, 4,700 patients (5,747 patient-years of exposure) were included in the worldwide LTG clinical trials database. In this cohort, 45 deaths were reported. Eighteen were judged by the panel to be SUDEP, 6 were defined as possible SUDEP, 20 were judged to be due to other causes (non-SUDEP), and 1 lacked sufficient data from which to make a classification. The overall SUDEP rate (definite/highly probable SUDEP and possible SUDEP combined) was calculated to be 3.5 in 1,000 patient-years of exposure to LTG. Conclusions: The rate of SUDEP in this cohort of patients was comparable to the rate that would be expected in young adults with severe epilepsy (the subgroup of patients believed to be at highest risk of SUDEP). The data suggest that the rate of SUDEP in the LTG clinical development program is a function of the clinical trial population and is unrelated to drug treatment.

Sudden unexpected death associated with seizures: analysis of 66 cases.

Abstract: Summary: We have analyzed 66 cases of sudden unexpected death (SUD) in persons with seizure disorders, which were examined by the Office of the Medical Examiner, Cook County (Chicago), Illinois. The individuals ranged in age from 10 months to 60 years (mean age, 28 years). Autopsy findings were insufficient to explain death, and there was no evidence of major systemic pathology. Approximately 40% of victims were found dead in bed, and the remainder in some other room at home, apparently having been engaged in normal activity. Several died in an emergency room following a seizure at home. Cardiopulmonary resuscitation was attempted but was ineffective. Neuropathological examination revealed brain lesions, which probably caused the seizures, in 60% of the cases. In 68% the anticonvulsant blood level was subtherapeutic or below detectable levels. The prevalence of seizure-associated SUE) may be between 1:525 and 1:2,100 among epileptics. The mechanism of death in these cases probably involves cardiac arrhythmias mediated by sympathetic autonomic events occurring during the seizure. RESUMEN Hemos analizado 66 casos de muerte subita imprevista (SUD) en personas con trastornos convulsivos que habian sido examinadas en la Oficina del Forenso en el Condado de Cook (Chicago), Illinois. La edad oscilaba entre 10 meses y 60 anos (media 28). Los hallazgos de la autopsia eran insuficientes para explicar la muerte y no se encontro patologia sistemica importante. Aproximadamente un 40% de las victimas fueron halladas muertas en la cama y el resto en otras habitaciones de la casa habiendose ocupado de actividades normales. Varios fueron trasladados a un servicio de urgencias, tras el ataque en sudomicilio, donde se intentaron medidas de resucitacion que fueron ineficaces. Los estudios neuropatologicos revelaron que el 60% de los casos tenian lesiones cerebrales, probable causa de sus ataques. En el 68% los niveles de anticonvulsivantes eran subterapeuticos o indetectables. La prevalencia de SUD asociada a ataques puede oscilar entre 1:525 y 1:2100 en los epilepticos. Los mecanismos de muerte en estos casos estan probablemente relacionados con arritmias cardiacas mediadas por acontecimientos autonomicos simpaticos que puedan ocurrir durante los ataques. ZUSAMMENFASSUNG Analyse von 66 Fallen eines plotzlichen und unerwarteten Todes (SUD) bei Anfallskranken, die vom Buro der Gesundheitsbehorde (Cook County, Chicago, Illinois) untersucht wurden. Das Durchschnittsalter betrug 28 Jahre (10 Monate bis 60 Jahre). Die Autopsiebefunde reichten nicht aus, um den Tod zu erklaren und es gab keine Hinweise auf eine grobe System-pathologie. Etwa 40% der Betroffenen wurden tot im Bett gefunden. Die ubrigen fand man,–offenbar ihrer normalen Tatigkeit nachgehend–in anderen Zimmern ihrer Wohnung. Mehrere wurden als Notfall nach einem hauslichen Anfall aufgenommen, nachdem Wiederbelebungsversuche wirkungslos geblieben waren. Die neuropathologische Untersuchung zeigte, das 60% Hirnlasionen hatten, die wahrscheinlich fur die Anfalle verant-wortlich waren. Bei 68% waren die Blutspiegel der Antikon-vulsiva im subtherapeutischen Bereich oder unterhalb der Nachweisgrenze. Die Pravalenz von Anfallen in Beziehung zum SUD mag bei Epileptikern zwischen 1:525 bis 1:2100 liegen. Der Mechanismus des Todes erfolgt in diesen Fallen wahrscheinlich auf Grund cardialer Arrhythmien im Gefolge sympathischer au-tonomer Dysregulationen, die wahrend des Anfalls erfolgen.

Cohort study of incidence of sudden unexplained death in persons with seizure disorder treated with antiepileptic drugs in Saskatchewan, Canada

Abstract: Summary: To measure the incidence of sudden unexplained death in treated persons with epilepsy (SUDEP) and to identify risk factors for SUDEP, a cohort of 6,044 persons aged 15–49 years with more than four prescriptions for antiepileptic drugs (AEDs) was identified from the Saskatchewan Health prescription drug file. To exclude subjects whose sudden deaths (SUDs) might be misattributed to another chronic underlying disease, subjects with hospitalizations for cancer or heart problems were excluded. To exclude subjects without epilepsy, subjects with >2-year AED treatment followed by AED-free time and subjects receiving < 1 U/day were excluded. The final cohort consisted of 3,688 subjects. Follow-up was started at the first AED prescription listed in the prescription drug file and ended at the earliest of the following: age 50 years, death, or last registration in the Saskatchewan Health. For 153 of 163 deaths occurring in the cohort, copies of anonymized death certificates were obtained and copies of anonymized autopsy reports of potential SUDEP cases were examined. There were 18 definite/probable SUDs and 21 possible SUDEPs, yielding a minimum incidence of 0.54 SUDEP per 1,000 person-years and a maximum of 1.35 SUDEP per 1,000 person-years. SUDEP incidence increased with male sex, number of AEDs ever prescribed, and prescription of psychotropic drugs and was highest in males with a history of treatment with three or more AEDs and four or more psychotropic drug prescriptions. Poisson regression showed a 1.7-fold increase in risk of SUDEP for each increment in maximum number of AEDs administered, a likely surrogate for severity and persistence of seizures.

Visual evoked potentials and postmortem findings in a case of cortical blindness.

Abstract: A patient with cortical blindness due to extensive bilateral posterior cerebral infarcts showed occipital visual evoked potentials to flash stimulation on repeated testing. These responses were probably mediated by extrageniculocalcarine connections between the optic nerve and the secondary visual cortex of the occipital convexity.

Evoked Potentials in Clinical Medicine

Abstract: Evoked potentials in clinical medicine , Evoked potentials in clinical medicine , کتابخانه مرکزی دانشگاه علوم پزشکی ایران

Cardiovascular effects of human insular cortex stimulation

Abstract: Recent investigations indicate a site of cardiac representation within the left insular cortex of the rat. Moreover, the results of lesion studies suggest left-sided insular dominance for sympathetic cardiovascular effects. It is unclear whether similar representation exists within the human insular cortex. Five epileptic patients underwent intraoperative insular stimulation prior to temporal lobectomy for seizure control. On stimulation of the left insular cortex, bradycardia and depressor responses were more frequently produced than tachycardia and pressor effects (p less than 0.005). The converse applied for the right insular cortex. We believe this to be the first demonstration of cardiovascular changes elicitable during insular stimulation in humans, and of lateralization of such responses for a cortical site. In humans, unlike the rat, there appears to be right-sided dominance for sympathetic effects. These findings may be of relevance in predicting the autonomic effects of stroke in humans and in the explanation of sudden unexpected epileptic death.

Practice parameter: Temporal lobe and localized neocortical resections for epilepsy Report of the Quality Standards Subcommittee of the American Academy of Neurology, in Association with the American Epilepsy Society and the American Association of Neurological Surgeons

Abstract: Objectives/Methods: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocor- tical resections for disabling complex partial seizures by systematic review and analysis of the literature since 1990. Results: One intention-to-treat Class I randomized, controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available. Conclusions: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least compara- ble. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.

Long-term prognosis of seizures with onset in childhood.

Abstract: Background The long-term prognosis of seizures that begin in childhood is uncertain. Methods We prospectively studied 245 children from the catchment area of Turku University Hospital in Turku, Finland, who had active epilepsy diagnosed between 1961 and 1964. Sixty-eight patients (28 percent) had idiopathic seizures (presumed to have a genetic origin), 54 (22 percent) had cryptogenic seizures (occurring in otherwise normal persons with no clear cause), and 123 (50 percent) had remote symptomatic seizures (with no immediate cause but occurring in persons with a prior brain injury or a static encephalopathy). Results At the final follow-up in 1992, we had sufficient data on 220 patients (90 percent), 176 of whom were alive and 44 of whom had died; the remaining 25 had emigrated, could not be traced, or declined to participate. Thirty-nine patients who died were not free of seizures at the time of death, and 33 had remote symptomatic seizures. Among the surviving patients, 112 (64 percent) had been seizure-f...