Prone position linked to epilepsy sudden death risk

By Eleanor McDermid, Senior medwireNews Reporter

Around three-quarters of patients who have a sudden unexpected death in epilepsy (SUDEP) are found lying in the prone position, show meta-analysis findings.

The meta-analysis confirms results from previous case series and suggests that SUDEP may have similar mechanisms to sudden infant death syndrome (SIDS), say James Tao and study co-authors, from The University of Chicago in Illinois, USA.

From 25 publications, the team identified 253 cases of SUDEP where the body position was recorded. Among these, 73.3% of patients died in a prone position and 26.7% in a non-prone position, they report in Neurology.

In an accompanying editorial, Barbara Dworetzky (Harvard Medical School, Boston, Massachusetts, USA) and Stephan Schuele (Feinberg School of Medicine, Chicago, Illinois, USA) say: “Discovering a possible modifiable risk factor for SUDEP, such as sleeping in the prone position, is clearly important because it implies the possibility of preventing a substantial number of deaths by having patients sleep on their back”.

In a subanalysis of patients with available demographic data, dying in the prone position was most likely among patients aged 40 years or younger, at 85.7% compared with 60.0% in older patients. The likelihood of being found in the prone position did not vary according to gender and whether patients were asleep or awake at the time of death.

Of note, the researchers identified 11 cases of SUDEP that occurred during video-electroencephalography (EEG) monitoring. All of these patients died in the prone position, and all had generalised tonic–clonic seizures and postictal generalised EEG suppression (PGES).

“Given that these monitored SUDEP cases have been randomly reported over a period of 25 years, these commonalities cannot be simply a matter of chance”, write Tao et al. “Instead, they likely reflect a common mechanism.”

They add that PGES is likely to be an EEG marker of impaired arousal, strengthening the similarities to SIDS.

In their editorial, Dworetzky and Schuele note the limitations of the research, including not knowing the predominant final body position of patients after surviving a generalised tonic–clonic seizure, and whether SUDEP patients frequently sleep in a prone position or move into one during a seizure.

“However, the study underlines that simple measures may have a substantial effect on SUDEP risk and that our efforts to attend to patients and bring them out of a prone position are worthwhile”, they conclude.

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