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. 2016 Jul;57(7):1161-8.
doi: 10.1111/epi.13419. Epub 2016 May 25.

Nonseizure SUDEP: Sudden unexpected death in epilepsy without preceding epileptic seizures

Samden D Lhatoo  1   2 , Maromi Nei  2   3 , Manoj Raghavan  4 , Michael Sperling  3 , Bilal Zonjy  1   2 , Nuria Lacuey  1   2 , Orrin Devinsky  2   5
Affiliations

Nonseizure SUDEP: Sudden unexpected death in epilepsy without preceding epileptic seizures

Samden D Lhatoo et al. Epilepsia. 2016 Jul.

Abstract

Objective: To describe the phenomenology of monitored sudden unexpected death in epilepsy (SUDEP) occurring in the interictal period where death occurs without a seizure preceding it.

Methods: We report a case series of monitored definite and probable SUDEP where no electroclinical evidence of underlying seizures was found preceding death.

Results: Three patients (two definite and one probable) had SUDEP. They had a typical high SUDEP risk profile with longstanding intractable epilepsy and frequent generalized tonic-clonic seizures (GTCS). All patients had varying patterns of respiratory and bradyarrhythmic cardiac dysfunction with profound electroencephalography (EEG) suppression. In two patients, patterns of cardiorespiratory failure were similar to those seen in some patients in the Mortality in Epilepsy Monitoring Units Study (MORTEMUS).

Significance: SUDEP almost always occur postictally, after GTCS and less commonly after a partial seizure. Monitored SUDEP or near-SUDEP cases without a seizure have not yet been reported in literature. When nonmonitored SUDEP occurs in an ambulatory setting without an overt seizure, the absence of EEG information prevents the exclusion of a subtle seizure. These cases confirm the existence of nonseizure SUDEP; such deaths may not be prevented by seizure detection-based devices. SUDEP risk in patients with epilepsy may constitute a spectrum of susceptibility wherein some are relatively immune, death occurs in others with frequent GTCS with one episode of seizure ultimately proving fatal, while in others still, death may occur even in the absence of a seizure. We emphasize the heterogeneity of SUDEP phenomena.

Keywords: EEG suppression; Near-SUDEP; Nonseizure SUDEP; Sudden unexpected death in epilepsy (SUDEP).

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Conflict of interest statement

Disclosures: None of the authors has any conflict of interest to disclose.

Figures

Figure 1
Figure 1
Sequence of cardiac, respiratory and EEG events in Case 1 (Figure 1a), Case 2 (Figure 1b) and Case 3 (Figure 1c) are shown. (CPR=cardiopulmonary resuscitation).
Figure 2
Figure 2
Sixty second record showing marked generalized EEG suppression and progressive bradycardia in Case 1.
See this image and copyright information in PMC

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