Faculty, Staff and Student Publications
Publication Date
9-1-2024
Journal
Annals of Clinical and Translational Neurology
Abstract
Objective: Sudden unexpected death in epilepsy (SUDEP) is a serious threat to individuals with intractable epilepsies, contributing to premature mortality. Understanding the elusive pathophysiological mechanisms of SUDEP, especially in cases without observable terminal events, remains a crucial area for investigation. This study aimed to shed light on the burden of epileptiform activity preceding SUDEP by utilizing an automated electronic seizure diary derived from a sensing-enabled thalamic deep brain stimulator (DBS).
Methods: Herein, we present the case of a 57-year-old man afflicted with intractable multifocal epilepsy secondary to cortical dysplasia and encephalomalacia resulting from severe traumatic brain injury. Despite an initial successful resection and subsequent resurgence of seizures necessitating DBS treatment, the patient tragically succumbed to SUDEP.
Results: In-depth analysis of the patient's electronic seizure diary, complemented by data from the sensing-enabled DBS, unveiled a terminal electrographic seizure. Notably, we observed a significant increase in power within specific frequency bands recorded from the thalamus preceding the terminal event. Furthermore, these heightened band power events displayed a discernible temporal clustering pattern, primarily manifesting during specific morning and evening hours. An autopsy conclusively confirmed the diagnosis of definite SUDEP.
Interpretation: This unique case report underscores the feasibility of harnessing thalamic DBS sensing capabilities to monitor seizure burden and, potentially, to tailor interventions aimed at reducing seizure frequency and associated mortality risks.
Keywords
Humans, Deep Brain Stimulation, Male, Middle Aged, Sudden Unexpected Death in Epilepsy, Drug Resistant Epilepsy, Thalamus, Seizures
DOI
10.1002/acn3.52153
PMID
39031004
PMCID
PMC11537140
PubMedCentral® Posted Date
7-19-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes