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Electrophysiological and clinical markers of SUDEP risk in pediatric epilepsy

Pinar Ozbudak1, Salih Akbas2, Alev Elci Karaduman3

  • 1Department of Pediatric Neurology, Ankara Etlik City Hospital, Ankara, Turkey.

Epileptic Disorders : International Epilepsy Journal with Videotape
|June 26, 2025
PubMed

Insights

Postictal generalized EEG suppression (PGES) is linked to higher SUDEP-7 scores in children, suggesting increased risk. Integrating EEG and body position monitoring may improve risk assessment for pediatric epilepsy patients.

Area of Science:

  • Neurology
  • Epileptology
  • Pediatric Medicine

Background:

  • Sudden unexpected death in epilepsy (SUDEP) is a significant cause of mortality in epilepsy, particularly drug-resistant forms.
  • Limited pediatric data and lack of specific risk assessment tools hinder effective SUDEP risk management in children.
  • Understanding factors associated with SUDEP risk is crucial for developing targeted interventions.

Purpose of the Study:

  • To evaluate the association between peri-ictal prone positioning, postictal generalized EEG suppression (PGES), and SUDEP-7 Inventory scores in pediatric epilepsy patients.
  • To identify potential biomarkers for SUDEP risk in children.
  • To explore the utility of existing risk assessment tools in a pediatric population.

Main Methods:

  • Retrospective review of 273 generalized convulsive seizures (GCS) from 117 pediatric patients undergoing video-EEG monitoring.
  • Assessment of seizure body position (prone vs. non-prone), PGES presence/duration, and SUDEP-7 Inventory scores.
  • Statistical comparisons between PGES-positive and -negative subgroups, and prone vs. non-prone seizure positions.

Main Results:

  • Postictal generalized EEG suppression (PGES) was observed in 50.4% of patients, with a mean duration of 120.5 seconds.
  • SUDEP-7 scores were significantly higher in PGES-positive patients (mean 7.04) compared to PGES-negative patients (mean 6.36; p=0.031).
  • Daytime GCS occurred significantly earlier after sleep onset (53.3 min) than nighttime GCS (131.4 min; p=0.001).

Conclusions:

  • Postictal generalized EEG suppression (PGES) is a reliable marker associated with higher SUDEP-7 scores, indicating potential increased SUDEP risk in children.
  • The SUDEP-7 Inventory, despite limitations, remains the most accessible clinical tool for pediatric SUDEP risk assessment.
  • Integrating EEG data and body position metrics can enhance individualized monitoring for pediatric epilepsy patients at risk of SUDEP.
Abstract

Keywords:
PGESSUDEPSUDEP‐7 inventorypediatric epilepsyprone positionrisk assessment

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