title: The incidence of peri-ictal prone position in patients with generalized convulsive seizures.
abstract: The objectives of this study were to determine the incidence of peri-ictal prone position in patients with generalized convulsive seizures (GCS) and to further assess the risk of sudden unexpected death in epilepsy (SUDEP) associated with the prone position.
  
  
  
  We retrospectively reviewed the video-EEG data of 308 GCS in 193 patients who underwent long-term video-EEG monitoring in two epilepsy centers. We determined the peri-ictal (preictal, ictal, and/or postictal) body positions.
  
  
  
  A peri-ictal prone position was observed in 12 (6.2%) of 193 patients and 13 (4.2%) of 308 GCS. In 5 (1.6%) of 308 GCS, patients in nonprone positions at seizure onset turned into the prone position during versive seizures. In 8 (2.6%) of 308 GCS, patients were sleeping prone at seizure onset. Peri-ictal intervention with body repositioning was provided in 11 of 12 patients and 12 of the 13 GCS. Repositioning was not provided during the remaining seizure; the patient died in the prone position. In the subset of 96 GCS without ictal intervention, patients in a supine position at seizure onset remained in the supine position at seizure termination in 57 (98.3%) of 58 GCS. Patients sleeping prone at seizure onset remained in the prone position at seizure termination in 4 (80%) of 5 GCS.
  
  
  
  Our data suggest that the incidence of peri-ictal prone position in patients with GCS is low. Both prone sleeping and forced ictal version may result in postictal prone position. Although avoiding prone sleeping may reduce the SUDEP risk, influencing forced ictal version may be difficult in the absence of supervision.
authors.affiliation: Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Neurology, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Staci
authors.initials: S
authors.lastname: Graf
authors.affiliation: Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Jiahui
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Neurology, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Naoum P
authors.initials: NP
authors.lastname: Issa
authors.affiliation: Department of Neurology, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Ahmer
authors.initials: A
authors.lastname: Ali
authors.affiliation: Department of Neurology, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rose
authors.affiliation: Department of Neurology, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Shasha
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Neurology, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: John
authors.initials: J
authors.lastname: Jacobsen
authors.affiliation: Section of Neurosurgery, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Warnke
authors.affiliation: Department of Neurology, The University of Chicago, Chicago, IL 60637, USA. Electronic address: jtao@neurology.bsd.uchicago.edu.
authors.forename: James X
authors.initials: JX
authors.lastname: Tao
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D012890:Sleep; D055815:Young Adult
keywords: Prone position; SIDS; SUDEP; Seizure; Sleep