Sudden death in epilepsy recorded in ambulatory EEG

McLean BN and Wimalaratna S (2007) Sudden death in epilepsy recorded in ambulatory EEG. J Neurol Neurosurg Psychiatry 78:12 1395–7.

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Abstract: A woman with epilepsy died during a seizure and the event was recorded on ambulatory EEG. The circumstances were typical of sudden death in epilepsy (SUDEP). The EEG revealed that the patient had suffered a generalised seizure that abruptly ended with cessation of all cerebral electrical activity. Two other cases recorded on videotelemetry demonstrating similar EEG features were reported in the literature. We postulate that abrupt irreversible cerebral electrical shutdown during a seizure may be the primary mechanism of SUDEP.

Context

• Single-case report of death during seizure recorded on ambulatory EEG, which shows sudden cessation of electrical activity. Patient had 46-year history of epilepsy. She was found dead in the morning by a friend and had pulmonary congestion on exam. EEG was consistent with seizure after 8 hours’ sleep, presumably near waking. EKG was not recorded and pulse artifact could not be recovered from the EEG. EEG signal went from polyspike/slow wave pattern to flat traces. The authors posit this ‘brain failure’ as the cause of death. Post-mortem revealed low/absent AED. The authors cite Earnest et al. (1992) as evidence for the critical causative role of pulmonary edema.