Andrew N. Wilner, MD


April 03, 2013

Sudden Unexpected Death in Epilepsy (SUDEP)

The next poster was titled, "Prone Position and SUDEP," by Liebenthal and Tao.[3] This study was a meta-analysis of 205 cases of SUDEP that have been reported in the literature. The positions in which the patients were found are as follow:

143 patients (69.8%) were prone

17 patients (8.3%) were supine

23 patients (11.2%) were sitting or in the lateral position

22 patients (10.7%) were in other positions

These associations between prone body position and SUDEP are similar to those found in sudden infant death syndrome. Body position could shed light on the mechanisms of sudden death and should be included in future reports.

Stereotactic-Guided Laser Ablation

The last poster is titled, "Stereotactic-Guided Laser Ablation of Epileptogenic Abnormalities in Intractable Focal Epilepsy: Preliminary Results," and the investigators are Chatman and colleagues.[4] This is a new technology using a laser inserted through a single burr hole without a craniotomy, marketed by a company called Visualase, Inc. (Houston, Texas). This report described 5 patients with focal epilepsy, 3 of whom had mesial temporal sclerosis. After the procedure, 2 of these latter patients were seizure-free. One had auras in the first week, which resolved thereafter. Adverse events included brachial plexitis, exacerbation of bipolar disorder, and suicidality.

The other 2 cases were patients with hypothalamic hamartoma. One patient had only 3 seizures in the 4 months after surgery, and the other patient had a 50% reduction in seizures. The median length of hospital stay was only 2 days. One patient required hospitalization postoperatively with acute hypothalamic dysfunction. The main advantage of this new procedure seems to be short length of stay and the lack of a craniotomy. The initial results seem good. However, significant adverse events were associated with the procedure. A randomized trial comparing this technique with conventional surgery is needed.

Take-Home Messages

I have summarized for you 4 posters out of more than 200 that were presented at the meeting on epilepsy. Here are the take-home messages.

Avoid valproate in MELAS;

Seizures after stroke are a marker for increased mortality;

Prone position is strongly associated with SUDEP; and

A new laser ablation technology is an alternative to resective surgery that may reduce the length of hospital stay but needs more evaluation.

This is Dr. Andrew Wilner reporting for Medscape at the 65th Annual Meeting of the American Academy of Neurology in San Diego, California. Thank you for listening.