title: Prone sleeping and SUDEP risk: The dynamics of body positions in nonfatal convulsive seizures.
abstract: Most victims of sudden unexpected death in epilepsy (SUDEP) are found prone with signs suggestive of an unwitnessed convulsive seizure (CS). Prone sleeping has been proposed as a risk factor for SUDEP. Little is known, however, about the change of body position during the course of CSs.
  
  
  
  We retrospectively reviewed video-EEG data and assessed body positions during the course of CSs, until there was a physical interaction by nursing staff with the subject.
  
  
  
  We identified 180 CSs in 90 individuals. In 16 of the 180 CSs (9%), the subject started in or turned to the prone position. Of the seven CSs that started in the prone position, three turned to a lateral position during the CS. In 13 CSs, the subject was in prone position at time of nursing intervention; nine (69%) of these started in a nonprone position.
  
  
  
  Our data suggest that the prone position occurs infrequently in closely supervised nonfatal CSs, a notable contrast to the number of victims of SUDEP found prone. Whether prone sleeping prior to CSs increases SUDEP risk, however, remains speculative, as body position during the course of a CS appeared to be dynamic.
authors.affiliation: Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Epilepsy Society, Chalfont St Peters, Bucks, SL9 0RJ, United Kingdom.
authors.forename: Sharon
authors.initials: S
authors.lastname: Shmuely
authors.affiliation: Department of Epileptology, University of Bonn, University Medical Center, 53127 Bonn, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Surges
authors.affiliation: Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Epilepsy Society, Chalfont St Peters, Bucks, SL9 0RJ, United Kingdom.
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
authors.affiliation: Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Epilepsy Society, Chalfont St Peters, Bucks, SL9 0RJ, United Kingdom; Department of Neurology, LUMC Leiden University Medical Center, Leiden, The Netherlands. Electronic address: rthijs@sein.nl.
authors.forename: Roland D
authors.initials: RD
authors.lastname: Thijs
mesh_terms: D003645:Death, Sudden / Q000209:etiology*; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications*; D006801:Humans; D011187:Posture; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000150:complications*; D012890:Sleep
keywords: Epilepsy; Prone position; Semiology; Sudden unexpected death in epilepsy (SUDEP)