Sudden death in MS or SUDMUS (1)

Hengstman & Kusters. Sudden cardiac death in multiple sclerosis caused by active demyelination of the medulla oblongata. Mult Scler. 2011 Sep;17(9):1146-8.

Cardiovascular autonomic dysfunction is not uncommon in multiple sclerosis (MS) and is related to the involvement of the autonomic areas of the brain that supply the heart; these are located in the area of the brain stem called the medulla oblongata. It has been suggested that involvement of these areas may contribute to the occurrence of sudden death in MS.

In this case report, the authors present a MS'er with active relapsing-remitting MS who died unexpectedly due to the sudden onset of cardiac arrythmias. Post-mortem examination showed the presence of active demyelinating lesions in the medulla oblongata. As far as they know, this is the first case report clearly linking sudden cardiac death to active MS on the histopathological level.

"Sudden death is very topical in view of the recent death of a patient on Fingolimod and the European Medicine Agency's decision to review the safety of the drug. I would be very interested to know if the unfortunate MS'er who died had involvement of the medulla oblongata that could have contributed to his or her death."

"Sudden death in MS or SUDMUS may be commoner than we think. In epilepsy, for example, it took decades for neurologists to recognise sudden death in epilepsy or SUDEP as being a major problem."

"I feel a research project coming on; we clearly need to get to the bottom of this issue before drawing premature conclusions about the fingolimod case."

CoI: multiple

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