Abstract, published in Frontiers in Neurology
Sudden unexpected death in epilepsy (SUDEP) claims the lives of one in every thousand epileptic patients each year, but the precise cause(s) had not yet been identified. The researchers propose a single sequence of causes and effects that collectively focus on obstructive apnea that occurs during the seizure itself. Obstructive apnea is a condition in which the muscles supporting the soft tissues in the throat (tongue & soft palate) temporarily relax, thereby narrowing or closing off the airway to cut off breathing.
Based on detailed animal studies that are sometimes impossible in humans, and striking parallels with a growing body of clinical examples, this framework (1) accounts for the autonomic, cardiac, and respiratory data to date by showing the causal relationships between specific elements, and (2) highlights specific kinds of data that can be used to precisely classify various patient outcomes. The framework also justifies a “near miss” designation to be applied to any cases with evidence of obstructive apnea even, and perhaps especially, in individuals that do not require resuscitation. Lastly, the rationale for preventative oxygen therapy is demonstrated.
With better mechanistic understanding of SUDEP, this team suggests changes for detection and classification to increase survival rates and improve risk stratification.