notsoshaihulud

SUDEP is rare, but that’s only because other people tend to be around during seizures.

What are you basing this statement on? (the causality part)

However, that doesn’t mean we should immediately default to “it was a hit that used one of those drugs.”

Of course. Occam's razor still applies here. But knowing how resistant ME/MDs (depending on state) to put "epilepsy" as the cause of death, the "it was seizures" explanation remains unusual. BTW, I ended up looking into it, so the chief ME's report is still pending. So it's not like anybody has final conclusions and everybody's speculating here.

Does that mean that 3% of seizures require intervention?

I should have put over 97%. But yeah for a generalized tonic-clonic seizure lasting longer than 5 minutes is called "status epilepticus" and that is a risk of lasting injury and thus warrant intervention. Just not the kind that bystanders are able to provide.

I would imagine the probabilities aren’t independent, but if they were, the probability of someone staying in the 97% for 10 seizures in a row is 73.7%. 20 seizures in a row drops the probability to 54%.

Yup, probabilities are not independent and if those clusters of seizures happen minutes to hours from each other, the risk of injury increases further. Also, with more and longer seizures the epilepsy tends to become increasingly harder to manage. But epilepsy comes in many shapes and forms so it depends on the specific kind. The adults who die of epilepsy usually don't die "unexpectedly" meaning they have certain comorbidities that increase the risk of dying (e.g. heart disease), etc.

Yeah my edit predates the reply by over 5 minutes.

You'll get the point for checking. Unfortunately this doesn't tell us what your original post was and I surely don't refresh continuously to see the edits when I send my responses. It's also entirely beside the point.

Intractable epilepsy (as in having frequent breakthrough seizures that is failed to be controlled on at least 2 adequately chosen medications), which I'd been repeatedly pointing to, may impact someone's ability to work as a judge and can absolutely lead to medical retirement. Also, SUDEP's incidence is about 1 in a 1000 patient years and the most telling part that epilepsy's still left off the causes of deaths of a third of those cases. https://www.neurology.org/doi/abs/10.1212/WNL.0000000000004094

Yeah, just because something is unusual, it doesn’t mean that another unusual explanation is automatically true.

your search engine implies “seizures” as the symptom but given the existence of provoked/symptomatic seizures, not all seizures meet criteria for epilepsy as your edit now suggests. And most epilepsies aren’t intractable. Which is the point about its impact on employment/ job duties.

Totally possible, but high risk patients’ medication switches happen in the EMU (epilepsy monitoring unit).

Again, we are missing a lot of information here.

I’m not interested in conspiracy theories and I’ve been ignoring these threads for that very reason, but again the “oh just seizures” take did raise my eyebrows. We don’t have enough information to make any judgment.

“ symptoms of epilepsy?” Epilepsy is not a symptom. Anyway, Google intractable epilepsy.

97% of seizures spontaneously stop in less than 5minutes. People on medication ( that they actually take), seizures tend to be shorter and in the setting of partial onset epilepsy (which is usually the case in adults) they are also more focal or shorter at breakthrough. So yeah, technically any seizure can kill you, but in reality they very rarely do. Also, the family of this person was comfortable having her alone in her home suggesting this hasn’t been a regular occurrence etc.

Of course, this doesn’t mean anything but again, it is unusual.

My only point is that a nonchalant “oh it was just seizures” statement raises a lot more questions than it eliminates. At least from an MD’s perspective.

But that’s usually a sudden cardiac arrhythmia. again I’m just saying that citing a very rare cause of death does not eliminate suspicion of foul play from a medical perspective, it amplifies it.

You again?:) unless she died of aspiration pneumonitis, based on the information we have, this seems to meet criteria for SUDEP where the theory is a generalized seizure hitting the brain stem leading to sudden arrhythmia and cardiac arrest or respiratory arrest. But since it is sudden, and unexpected, there are very few instances captured on EMU. Also, it doesn’t seem likely that she was suffering from intractable epilepsy, otherwise she wouldn’t have been able to fulfill her duties as a judge, it’s always possible that she just stopped taking her medications, but even in that situation SUDEP remains rare. But please, tell me more about your Google search.