Prone position linked to epilepsy sudden death threat.
Approximately three quarters of patients who have a sudden unexpected death in epilepsy (SUDEP) are discovered lying in the prone posture, demonstrate meta-evaluation findings.
The meta-evaluation supports results from previous case series and indicates that SUDEP may have similar mechanics to sudden infant death syndrome (SIDS), say James Tao and study coauthors, from The University of Chicago in Illinois, USA.
From 25 publications, the team identified 253 cases of SUDEP where the body posture was recorded. Among these, 73.3% of patients died in a prone position and 26.7% in a non-prone location, 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: “Finding a potential modifiable risk factor for SUDEP, including sleeping in the prone posture, is certainly significant as it suggests the chance of preventing a considerable variety of departures by having patients sleep on their back”.
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In a evaluation of patients with available demographic data, expiring in the prone position was most likely among patients aged 40 years or younger, at 85.7% compared with 60.0% in elderly patients. The odds of being discovered in the prone position didn’t change according to sex and whether patients were sleeping or awake in the time of departure.
Of note, the researchers identified 11 cases of SUDEP that happened 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 tracked SUDEP instances have been at random reported over a span of 25 years, these commonalities cannot be just an issue of opportunity”, compose Tao et al. “Instead, they probably represent a standard mechanism.”
They include that PGES will probably be an EEG mark of impaired arousal, reinforcing the likenesses to SIDS.
Within their editorial, Dworetzky and Schuele note the restrictions of the research, including not realizing the overriding closing body location of patients after living a generalised tonic-clonic seizure, and whether SUDEP patients often sleep in a prone position or move into one during a seizure.
“Nevertheless, the study underlines that straightforward measures might have a considerable effect on SUDEP threat and that our attempts to attend to patients and bring them out of a prone posture are rewarding”, they reason.