Abstracts

Rationale: Sudden unexpected death in epilepsy (SUDEP) often occurs during sleep, in bed and as an un-witnessed event. Patients are usually found in prone position. Prone position may be a risk factor for SUDEP. Our goal is to determine the prevalence of pre-and post-ictal prone position in patients with generalized convulsive seizures (GCS). Methods: We retrospectively reviewed the video-EEG of 92 patients with 126 GCS during long term video-EEG monitoring. We determined the pre-and post-ictal body positions (Supine, lateral, sitting and prone) in these patients. We also investigated whether factors such as age, sex, sleep (diurnal vs. nocturnal GCS), and peri-ictal nursing intervention influenced the prevalence of their body positions. Results: Of these 126 GCS, pre-ictal body positions were sub-categorized into 56% (70/126) supine, 21% (27/126) lateral, 21% (26/126) sitting, and 2% (3/126) prone. Post-ictal body positions were sub-categorized into 55% (69/126) lateral, 42% (53/126) supine, 2% (3/126) sitting, and 1% (1/126) prone. Fifty-nine percent (74/126) of GCS were diurnal seizures, whereas 41% (52/126) of GCS were nocturnal seizures. Three patients with pre-ictal prone position were all associated with nocturnal GCS. Peri-ictal nursing intervention was provided in 64% (81/126) of GCS. Of the three pre-ictal prone patients, nursing intervention was provided in two patients who were subsequently turned into lateral position. Unfortunately, it was not provided in remaining prone patient who subsequently died of SUDEP. Conclusions: Our preliminary data suggested that the prevalence of pre-ictal prone body position is relatively low (2%) in the video-EEG monitored patients, but it is highly associated with nocturnal seizures. As such, prone position may contribute to the SUDEP risk associated with sleep. Peri-ictal nursing supervision may be preventive of SUDEP.