Identifying people who are at risk of SUDEP

Grant round winners 2013

Sudden unexpected death in epilepsy (SUDEP) accounts for approximately 18% of epilepsy-related deaths. There are a number of factors that are thought to increase the risk of SUDEP, including early onset of epilepsy, poor drug compliance and age; however there are certainly other more fundamental ones that have not yet been confirmed. More research is urgently needed, in order that a means of identifying people who are at risk can be developed and preventative measures can be taken. 

Dr Shane Delamont and colleagues, at King’s College Hospital, previously found that, following some seizures, certain people had altered EEG recordings. They wondered if these changes, known as depressions, might have a significant impact upon heart function and breathing, and increase the risk of sudden death. The group has now been awarded £27,998 over 12 months, to carry out a pilot grant entitled New physiological markers of seizures, in which they will explore the EEG depressions in more detail.

During the study, the team plans to recruit 20 people with severe and/or drug resistant (refractory) epilepsy, who are being considered for epilepsy surgery. Subjects will then be monitored intensively before, during and after a seizure; and information about their brain activity, heart rhythm, breathing and blood oxygen content (known as oxygen saturation) will be collected. The researchers hope to obtain complete information for at least one seizure from all 20 participants.

Once the data have been collated, they will be analysed to see if the depressions in brain activity recorded correspond with changes in heart rhythm, breathing and oxygen saturation. If this is found to be the case, the results will form the basis of a larger investigation into the link between electrical depression and heart and breathing functions.

Through this and follow-up studies, it might eventually be possible to routinely identify people who experience depressions in brain activity following some seizures, and who are therefore at a particularly high risk of SUDEP. It will then be important to sensitively inform them of this risk and provide clear advice on how it can be decreased (e.g. having seizure alarms). In the longer term, interventions that block the mechanisms underlying SUDEP might also become available.

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