What Leads to Sudden Unexpected Death in Epilepsy?

Sudden Unexpected Death in Epilepsy (SUDEP) is defined as the death of an otherwise healthy person with epilepsy that occurs either after a seizure or even when there is no recent seizure activity. What leads to SUDEP and who is at risk? How can we prevent it?

Dr. Hiroshi Otsubo’s findings suggest a possible mechanism for SUDEP following a tonic-clonic (grand mal) seizure. After a tonic-clonic seizure, there is usually a short period of lowered brain activity. Using electroencephalography (EEG) brain wave recordings, this lowered brain activity can be seen as a “flattening” of brain waves. This flattened EEG pattern has been called Postictal-Generalized EEG Suppression or PGES.

Typically, PGES passes without harm and the patient awakens shortly after the tonic-clonic seizure is over. However, Dr. Otsubo believes that after a very strong tonic-clonic seizure, a deep and prolonged PGES can occur. This type of PGES can potentially stop a person’s breathing and result in death, even in patients who are otherwise healthy. Dr. Otsubo's research is currently focused on better understanding this connection between PGES and SUDEP.

Based on this research, Dr. Otsubo hopes to find ways to reduce the risk of SUDEP in children. The next question Dr. Otsubo plans to examine is whether we can find drugs to prevent SUDEP in patients who are at risk.


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