“Sudden unexpected death is the main cause of death in uncontrolled epilepsy and usually occurs unwitnessed during sleep,” said study author James Tao, MD, PhD, associate professor of neurology at the University of Chicago. “Our findings highlight an important strategy for preventing sudden unexpected death in epilepsy — that ‘back is best.”
Epilepsy is a brain disorder that causes repeated seizures over time and affects an estimated 50 million people worldwide. Patients with tonic clonic seizures (formerly known as grand mal seizures) that affect the entire brain are more likely to die suddenly than people with partial seizures that affect an area of the brain.
For the study, Tao and his colleagues reviewed 25 studies that included 253 sudden unexpected death cases where body position was recorded. They found that 73 percent of the cases died in the stomach sleep position, whereas 27 percent died in other sleep positions. Looking at a subgroup of 88 people, they found that people younger than 40 were four times more likely to be found on their stomachs at the time of sudden death than people over 40. A total of 86 percent of those under 40 were sleeping on their stomachs, compared to 60 percent for those over the age of 40.
“We’re not sure why this was more common in younger people,” Tao said. “It may be that they are more likely to be single and not have anyone with them during a seizure while sleeping.”
A total of 11 cases of sudden death have occurred while the people were being monitored with video EEG and their sleeping position was recorded. In all of those cases, all the people were died in a prone position, and most of these people were sleeping on their stomachs before the terminal seizures.
“Similar to infant SIDS cases, adults often have an impaired ability to wake up after a seizure, especially a general seizure,” he said.
Tao notes that a person sleeping with someone who has a generalized tonic clonic seizure while on their stomach should help them turn over or on the side during or after the seizure.
“Using wrist watches and bed alarms designed to detect seizures during sleep may also help prevent these deaths,” he added.
Additional authors for the study, “Association of prone position with sudden unexpected death in epilepsy,” include Jennifer Liebenthal, Shasha Wu, Sandra Rose and John Ebersole.
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