title: Severe pulmonary congestion in a near miss at the first seizure: further evidence for respiratory dysfunction in sudden unexpected death in epilepsy.
abstract: Sudden unexpected death in epilepsy (SUDEP) is the most important direct seizure-related cause of death, and most cases usually occur in patients with intractable, longstanding epilepsy. Suspected mechanisms for SUDEP include central and obstructive apnea, cardiac arrhythmia, postictal respiratory arrest, and primary cessation of brain activity. We report a patient who experienced a near SUDEP following his first prolonged tonic-clonic seizure requiring intubation. Chest X-ray examination showed severe bilateral congestion of the middle and superior pulmonary fields and an enlarged heart. Observations of pulmonary compromise in near-miss patients are extremely rare. Our patient showed marked cyanosis and respiratory distress after the index seizure, in agreement with the view that respiratory distress was the primary etiology in this case. Moreover, this observation confirms that SUDEP is not exclusively an issue for patients with chronic, uncontrolled epilepsy.
authors.affiliation: Department of Neurological Sciences, Epilepsy Center, Federico II University, Naples, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Pezzella
authors.forename: Pasquale
authors.initials: P
authors.lastname: Striano
authors.forename: Clotilde
authors.initials: C
authors.lastname: Ciampa
authors.forename: Luca
authors.initials: L
authors.lastname: Errichiello
authors.forename: Pietro
authors.initials: P
authors.lastname: Penza
authors.forename: Salvatore
authors.initials: S
authors.lastname: Striano
mesh_terms: D000293:Adolescent; D003645:Death, Sudden / Q000209:etiology*; D004827:Epilepsy / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D012120:Respiration Disorders / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods