title: Ictal central apnea as a predictor for sudden unexpected death in epilepsy.
abstract: 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.
authors.affiliation: Department of Neurology, Northwestern University, Chicago, IL 60611, USA. s-schuele@northwestern.edu
authors.forename: Stephan U
authors.initials: SU
authors.lastname: Schuele
authors.forename: Mitra
authors.initials: M
authors.lastname: Afshari
authors.forename: Zahra S
authors.initials: ZS
authors.lastname: Afshari
authors.forename: Michael P
authors.initials: MP
authors.lastname: Macken
authors.forename: Jorge
authors.initials: J
authors.lastname: Asconape
authors.forename: Lisa
authors.initials: L
authors.lastname: Wolfe
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Gerard
mesh_terms: D000328:Adult; D003645:Death, Sudden; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications*; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D020182:Sleep Apnea, Central / Q000209:etiology*