Abstracts

Rationale: Sudden unexpected death in epilepsy (SUDEP) is the primary cause of mortality among people with epilepsy. SUDEP patients commonly die during sleep, in bed, and in the prone position. While the prone body position at seizure termination has been regarded as a potential risk factor for SUDEP, the prevalence of this position among SUDEP patients has not been analyzed on a large scale. Our goal is to determine the prevalence of prone body position in patients with SUDEP.Methods: The study was conducted as a meta-analysis, based on a Pub-Med search, using keywords SUDEP or sudden unexpected death in epilepsy or sudden unexplained death syndrome in epilepsy. This search resulted in 517 publications meeting this criterion, of which 205 cases from 32 publications described SUDEP cases in which the body position of patients were described at the time of death. Results: Of the 205 SUDEP cases with known body positions, 143 (69.8%) were found in the prone position, 17 (8.29%) were in the supine position, 23 (11.2%) were found in lateral/sitting positions, and 22 (10.7%) were in a position other than prone at the time of death. Eighty-two of 205 deaths were reported as either witnessed or unwitnessed. Only 6 (7.32%) deaths were witnessed, compared to 76 (92.7%) unwitnessed cases. The scene of death was known in 98 of these cases. Of these, 69 (70.4%) were in bed; the remaining 29 cases were elsewhere.Conclusions: There is a significant association between the prone body position and SUDEP. This finding indicates that the prone body position is an important risk factor for SUDEP.