Acid reflux induced laryngospasm as a potential mechanism of sudden death in epilepsy

Ryan B. Budde, Muhammad A. Arafat, Daniel J. Pederson, Thelma A. Lovick, John G.R. Jefferys, Pedro P. Irazoqui*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

8 Citations (Scopus)
131 Downloads (Pure)

Abstract

Objective: 

Recent research suggests that obstructive laryngospasm and consequent respiratory arrest may be a mechanism in sudden unexpected death in epilepsy. We sought to test a new hypothesis that this laryngospasm is caused by seizures driving reflux of stomach acid into the larynx, rather than spontaneous pathological activity in the recurrent laryngeal nerve. 

Approach: 

We used an acute kainic acid model under urethane anesthesia to observe seizure activity in Long−Evans rats. We measured the pH in the esophagus and respiratory activity. In a subset of experiments, we blocked acid movement up the esophagus with a balloon catheter. 

Main results: 

In all cases of sudden death, terminal apnea was preceded by a large pH drop from 7 to 2 in the esophagus. In several animals we observed acidic fluid exiting the mouth, sometimes in large quantities. In animals where acid movement was blocked, sudden deaths did not occur. No acid was detected in controls. 

Significance:

The results suggest that acid movement up the esophagus is a trigger for sudden death in KA induced seizures. The fact that blocking acid also eliminates sudden death implies causation. These results may provide insight to the mechanism of SUDEP in humans.

Original languageEnglish
Pages (from-to)23-31
Number of pages9
JournalEpilepsy Research
Volume148
Early online date9 Oct 2018
DOIs
Publication statusPublished - Dec 2018

Fingerprint Dive into the research topics of 'Acid reflux induced laryngospasm as a potential mechanism of sudden death in epilepsy'. Together they form a unique fingerprint.

Cite this