Seizures, Cerebral Shutdown, and SUDEP

Abstract

Several potential pathophysiologic phenomena, including "cerebral shutdown," are postulated to be responsible for SUDEP. Since the evidence for a seizure-related mechanism is strong, a poor understanding of the physiology of human seizure termination is a major handicap. However, rather than a failure of a single homeostatic mechanism, such as postictal arousal, it may be a "perfect storm" created by the lining up of a several factors that lead to death.

FIGURE 1.

Intracranial EEG of the generalized tonic–clonic seizure of a patient with MRI negative left temporal lobe epilepsy showing 1. onset of profound EEG suppression even before the end of the generalized clonic phase and 2. onset of postictal generalized EEG suppression.

FIGURE 2.

Intracranial EEG recordings showing asymmetric generalized tonic–clonic seizure termination beginning in the left hemisphere (1) followed 11 seconds later by seizure end in the right hemisphere.