1. Postictal generalized EEG suppression: a potential biomarker for sudep
Elizabeth Donner, MD, MSc, FRCPC
The Hospital for Sick Children
University of Toronto

2. Searching for a biomarker…
Objectively measured characteristic that predicts a clinical state
People with drug resistant epilepsy have hundreds of seizures and survive
What distinguishes the SUDEP patient from the rest?
What distinguishes the fatal event from past seizures?

3. SUDEP CHRONIC EPILEPSY
Theoretical considerations for mechanism of SUDEP
Intrinsic
factors
CHRONIC EPILEPSY
Precipitating Seizure
Respiratory arrest
Cardiac arrest
Electrocerebral shutdown
SUDEP
Extrinsic
factors
Altered brain function/structure
Autonomic dysfunction
Altered heart function/structure
Genetic factors
AED management changes
Sleep environment
Poor AED adherance
Prolonged
postictal state
Lack of supervision

4. Mechanisms
Witnessed, EMU-recorded events support a seizure, typically GTC, as the terminal event
3 main mechanism emerge from EMU cases:
Primary respiratory causes: central or obstructive apnea
Cardiac arrhythmias
Cerebral shutdown: diffuse post-ictal suppression of EEG preceding EKG or respiratory changes
Friedman et al. JCI 2013