Peri-ictal Respiratory Depression Leading to Sudden Unexpected Death in Epilepsy: A Report of Two Cases
Abstract number :
3.442
Submission category :
18. Case Studies
Year :
2018
Submission ID :
502735
Source :
www.aesnet.org
Presentation date :
12/3/2018 1:55:12 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
Sandra Rose, University of Chicago; Raisa Martinez, University of Chicago; Naoum P. Issa, University of Chicago; Shasha Wu, University of Chicago; Xi Liu, Zhongnan Hospital of Wuhan University; Taixin Sun, Beijing Electric Power Hospital; and James X. Tao
Rationale: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of premature death in patients with chronic refractory epilepsy. Seizure-induced peri-ictal central apnea has been proposed as a possible mechanism of SUDEP. However, definitive evidence supporting the hypothesis remains elusive. Here, we report two SUDEP cases in which peri-ictal respiratory depression was likely the direct cause of death. Methods: Case one: A 70-year-old woman was undergoing mechanical ventilation and video-EEG monitoring following an episode of periictal hypoventilation and oxygen desaturation (SpO2 80). She subsequently had a generalized tonic-clonic seizure (GTCS) lasting for 3 min and developed irreversible generalized postictal EEG suppression (PGES) despite stable vital signs including heart rate, blood pressure and oxygen saturation. She died of diffuse cerebral edema and herniation 12 hours later. Autopsy revealed no clear causes of death, other than hypoxic ischemic changes possibly leading to the diffuse cerebral edema.Case two: A 28-year-old man underwent invasive EEG monitoring with depth electrode placement during pre-surgical evaluation. He was in stable condition after the implantation on postoperative day one and suddenly had a cluster of three GTCS without reduction of preoperative antiepileptic drugs (AEDs). The postictal intracranial EEG was markedly suppressed. He was in acute respiratory distress immediately after the third seizure and developed cardiorespiratory arrest in a supine position. He was resuscitated and transferred to the neuro-intensive care unit and recovered, despite the complications of severe metabolic acidosis and ventricular tachycardia. He fully recovered and was discharged days later. Unfortunately, he died of SUDEP two years later after a similar GTCS witnessed by a family member at home. Results: Seizure-induced peri-ictal respiratory depression was likely the cause of death in these two cases. Conclusions: Peri-ictal patient care was not effective in preventing the SUDEP in the first case, and only delayed SUDEP in the second case, underscoring the challenge of SUDEP prevention related to seizure-induced peri-ictal respiratory depression. Funding: None