Epileptic Disord. 2025 Jun 26. doi: 10.1002/epd2.70057. Online ahead of print.
ABSTRACT
OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is a major cause of epilepsy-related mortality, especially in patients with drug-resistant epilepsy. However, pediatric data remain limited, and specific risk assessment tools for children are lacking. This study evaluates the association between peri-ictal prone positioning, postictal generalized EEG suppression (PGES), and SUDEP-7 Inventory scores in pediatric patients with epilepsy.
METHODS: A retrospective review was conducted on 273 generalized convulsive seizures (GCS) from 117 pediatric patients who underwent video-EEG monitoring from 2002 to 2022. We assessed body position during seizures, PGES presence and duration, and SUDEP-7 Inventory scores. Statistical comparisons were made across PGES-positive and -negative, and prone vs. non-prone subgroups.
RESULTS: Prone positioning occurred in 5.86% of seizures, with 91.6% of prone-onset seizures remaining in the prone position throughout. PGES was present in 50.4% of patients (mean duration: 120.5 s). SUDEP-7 scores were significantly higher in PGES-positive patients (mean: 7.04) compared to PGES-negative (mean: 6.36; p = 0.031). Daytime GCS occurred significantly earlier after sleep onset than night time GCS (53.3 vs. 131.4 minutes; p = 0.001).
SIGNIFICANCE: PGES appears to be a reliable marker associated with higher SUDEP-7 scores and may indicate increased SUDEP risk in children. While SUDEP-7 has limitations in pediatric use, it remains the most accessible clinical tool. Integrating EEG and body position metrics could enhance individualized monitoring for pediatric patients at risk.
PMID:40569567 | DOI:10.1002/epd2.70057
