Ictal central apnea as a predictor for sudden unexpected death in epilepsy


      Epidemiological evidence associating ictal hypoventilation during focal seizures with a heightened risk for subsequent sudden unexpected death in epilepsy (SUDEP) is lacking. We describe a patient with temporal lobe epilepsy with two focal seizures recorded in the epilepsy monitoring unit that were associated with central apnea lasting 57 and 58 seconds. During these events, she demonstrated oxygen desaturation down to 68 and 62%. The patient subsequently died at home from autopsy-confirmed SUDEP. The family was not alerted of any seizure activity by the auditory alarm system in her room nor by sleeping in the adjacent room with open doors. This case emphasizes the fact that ictal hypoxia and SUDEP may occur in seizures without noticeable convulsive activity. The report gives credibility to the growing body of literature suggesting that epilepsies affecting the autonomic nervous system may predispose to SUDEP independent of the effects of a secondary generalized convulsion.


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        • Bateman L.M.
        • Spitz M.
        • Seyal M.
        Ictal hypoventilation contributes to cardiac arrhythmia and SUDEP: report on two deaths in video-EEG-monitored patients.
        Epilepsia. 2010; 51: 916-920
        • Tao J.X.
        • Qian S.
        • Baldwin M.
        • et al.
        SUDEP, suspected positional airway obstruction, and hypoventilation in postictal coma.
        Epilepsia. 2010; 51: 2344-2347
        • So E.L.
        • Sam M.C.
        • Lagerlund T.L.
        Postictal central apnea as a cause of SUDEP: evidence from near-SUDEP incident.
        Epilepsia. 2000; 41: 1494-1497
        • Bateman L.M.
        • Li C.S.
        • Seyal M.
        Ictal hypoxemia in localization-related epilepsy: analysis of incidence, severity and risk factors.
        Brain. 2008; 131: 3239-3245
        • Hesdorffer D.C.
        • Tomson T.
        • Benn E.
        • et al.
        Combined analysis of risk factors for SUDEP.
        Epilepsia. 2011; 52: 1150-1159
        • Lhatoo S.D.
        • Faulkner H.J.
        • Dembny K.
        • Trippick K.
        • Johnson C.
        • Bird J.M.
        An electroclinical case–control study of sudden unexpected death in epilepsy.
        Ann Neurol. 2010; 68: 787-796
        • Nei M.
        • Ho R.T.
        • Abou-Khalil B.W.
        • et al.
        EEG and ECG in sudden unexplained death in epilepsy.
        Epilepsia. 2004; 45: 338-345
        • Seyal M.
        • Bateman L.M.
        Ictal apnea linked to contralateral spread of temporal lobe seizures: intracranial EEG recordings in refractory temporal lobe epilepsy.
        Epilepsia. 2009; 50: 2557-2562
        • Nashef L.
        • Fish D.R.
        • Garner S.
        • Sander J.W.
        • Shorvon S.D.
        Sudden death in epilepsy: a study of incidence in a young cohort with epilepsy and learning difficulty.
        Epilepsia. 1995; 36: 1187-1194
        • Yung I.
        • Rose S.
        • Hawes-Ebersole S.
        • Ebersole J.
        • Tao J.
        Convergence of ictal hypoxia and postictal hypoventilation as a potential mechanism of SUDEP [abstract].
        Epilepsia. 2010; : A1.098