R&B icon Teena Marie may have died from suffering a grand mal seizure, according to reports that are surfacing after the star was found dead in her Pasadena home the day after Christmas.
Sudden unexplained death in epilepsy, or SUDEP, is typically associated with these most intense seizures and likely results from problems with breathing or heart rhythm, said Dr. Jacqueline French of NYU Medical Center and the American Academy of Neurology.
Yet researchers still aren't certain about the exact mechanism by which it leads to death, and caution that it isn't very common among all patients with seizures.
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"When seizures aren't controlled, there's a small risk of sudden unexplained death," French told MedPage Today. "But 99 percent of the time when people have a seizure, that doesn't occur."
There has been some speculation that the singer may have been treated for epilepsy. According to entertainment website TMZ.com, the Los Angeles County coroner's office found diazepam (Valium) in her home, which friends say she stopped taking due to side effects before switching to herbal remedies.
The website also reported that she has suffered other seizures, as well as another grand mal only a month ago. She allegedly had requested that someone always accompany her to bed in fear that she would have another.
Dr. Shlomo Shinnar of Albert Einstein College of Medicine in Bronx, N.Y., said withdrawal from a benzodiazepine like Valium can trigger seizures, even in the general population. For an epileptic patient, he said, coming off seizure control medication certainly increases the risk of convulsions.
"If you have a seizure disorder and you stop taking your medications, then you increase your risk of seizure and that can happen the next day, two weeks later, or two months later," he told MedPage Today.
Last week in the New England Journal of Medicine, Shinnar and a colleague reported that patients diagnosed with epilepsy as children have higher rates of death than the general population. In fact, almost 10 percent of these deaths were sudden and unexplained -- even in patients who'd been in remission without medication for many years.
Epilepsy Can Strike Adults, Too
But epilepsy -- diagnosed after at least two seizures or one plus evidence from electroencephalography -- also manifests in adults, which accounts for about half of all cases of the disease, Shinnar said.
"Many people have this firmly held belief that if you have epilepsy, it's going to happen in childhood or not at all, and that's just not true," French said. "A seizure and epilepsy can occur at any age."
Adult onset typically occurs after age 60, and is usually associated with an event such as trauma or a stroke, but cases do occur in 30, 40, and 50-year-old patients, Shinnar said. Teena Marie was 54.
Dr. Orrin Devinsky, director of the NYU Epilepsy Center, said numerous other causes can lead to seizures in patients who don't have epilepsy -- tumors, blood vessel abnormalities, or inflammation due to conditions such as autoimmune disorders or infections.
Some aspects of celebrity culture are also associated with an increased risk of seizures, including cocaine use or alcoholism -- either due to withdrawal or head traumas suffered while intoxicated, said Steven Pacia, chief of neurology at Lenox Hill Hospital in Manhattan.
The singer struggled with addiction to prescription painkillers following the death of her partner Rick James in 2004, but was successfully detoxed, according to Associated Press reports.
Pacia said an autopsy will reveal more information, as forensic scientists will look for clues such as a bitten tongue, pulmonary edema, or evidence of violent muscle contractions to confirm whether Teena Marie did indeed have a seizure.
Although, without an actual witness to the seizure, he said, it's hard to be 100 percent certain.
Dr. Cynthia Harden, chief of epilepsy and electroencephalography at Long Island Jewish Hospital, said the best way to prevent death from seizures is to control the underlying problem.
"[You have to] prevent seizures themselves with aggressive and appropriate treatment," she said. "Patients and doctors should openly discuss the rare possibility of death, which is a somewhat overlooked risk of having a seizure disorder, so that the full seriousness of epilepsy can be appreciated."