Abstracts

Rationale: Sudden Unexpected Death in Epilepsy (SUDEP) encompasses cases of abrupt and unforeseen demise in individuals with epilepsy, including those classified as near-SUDEP where cardiorespiratory arrest is reversed by resuscitation efforts leading to survival for more than one hour [1] [2]. Our study presents a near SUDEP patient with refractory epilepsy, highlighting challenges in managing complex epilepsy surgery cases needing intracranial monitoring, not able to be performed at a community hospital in underserved communities. Due to lack of resources for optimal surgical management such as access to a level 4 NAEC (National Association of Epilepsy Centers), a pacemaker was implanted to prevent future cardiac-related SUDEP events.




Methods: N/A

Results: A 54-year-old, right-handed male, with a history of refractory focal epilepsy, major depressive disorder and psychosis was admitted to a level 3 Epilepsy Center’s Epilepsy Monitoring Unit (EMU) for localization of ictal onset. During the EMU evaluation, the patient experienced one electroclinical seizure lasting 140-seconds, followed by postictal diffuse EEG background suppression lasting 90-seconds. Postictally, patient underwent an undefined duration of apnea due to the respiratory parameters not being monitored during EMU evaluation. Sixty seconds before the clinical seizure ended, cardiac telemetry monitoring showed sinus rhythm transitioned to sinus bradycardia and 13-seconds later in the postictal phase, transitioned into cardiac asystole lasting for a duration of 70-seconds. CPR (Cardiopulmonary Resuscitation) was initiated 90-seconds after the onset of apnea, subsequently return of spontaneous circulation (ROSC) was achieved. The patient underwent a pacemaker implantation which continues to pace effectively. The most recent six-month time frame noted 25% right atrial pacing, < 0.1% right ventricular pacing with sinus rhythm and no cardiac events. We propose that pacemaker implantation may provide a safeguard against SUDEP, by preventing asystole during future episodes of seizures.


Conclusions: Our case demonstrates challenges in accessing optimal management for refractory epilepsy patients at high risk of SUDEP due to socioeconomic barriers. Due to the patient’s psychiatric condition, poor social support system and socioeconomic status, and unwillingness to travel for care at a level 4 NAEC, leading to the decision for pacemaker implantation to prevent future near SUDEP and associated cardiac asystole.

Funding: None