Postural change in convulsive seizures: a retrospective review of video-electroencephalographic recordings

Prone position has been identified as an important risk factor for sudden unexpected death in epilepsy raising the possibility of avoidance of this posture in sleep as a preventative measure.

To evaluate the potential utility of prone posture position, we studied patterns of postural change during generalised tonic clonic seizures.

Video-electroencephalographic recordings of patients undergoing investigations at the Royal Brisbane and Women's Hospital between 2005 and 2013 were reviewed independently by two raters. Head and truncal positions (left and right lateral, supine, sitting, prone) at seizure onset and offset, before and after nurse interventions were recorded. Post-ictal postural changes and evidence of stertorous respirations were also recorded.

Thirty-one seizures from 27 patients were included in the study. One seizure began with the patient asleep in the prone position. One patient became prone during a seizure, having previously been asleep in the left lateral position. Nine patients changed position during a seizure. Seven of these patients were sitting or in a lateral position at the time of seizure onset, two patients were supine at seizure onset. No patient rolled by more than 90° during a seizure. Post-ictal stertorous respirations were observed in 14 patients, one of whom was prone.

The incidence of patients attaining a prone position during a seizure was low. Given that no patient rolled more than 90°, patients are least likely to attain a prone position if they are supine at the beginning of a seizure.