EEG suppression after seizures may signal increased SUDEP risk in children with epilepsy, according to a new study evaluating clinical and electrophysiological indicators. Researchers examined video-EEG data from 117 pediatric patients to better understand how postictal generalized EEG suppression (PGES), prone positioning during seizures, and SUDEP-7 Inventory scores correlate in this vulnerable population.
In this retrospective review, 273 generalized convulsive seizures recorded over a 20-year period were analyzed to identify markers associated with heightened risk of sudden unexpected death in epilepsy (SUDEP). PGES was present in just over half of the patients and had a mean duration of two minutes. Notably, SUDEP-7 scores were significantly higher in children who exhibited PGES compared to those who did not. This finding points to PGES as a potential surrogate biomarker for elevated SUDEP risk in pediatric patients.
Although prone positioning occurred in only a small fraction of seizures, under 6 percent, the majority of those that began prone remained so throughout the event. Given the established concern that prone positioning may hinder arousal and breathing, this reinforces its relevance in the overall risk landscape.
The study also found that generalized convulsive seizures occurring during the day happened significantly earlier in the sleep cycle than nighttime seizures, offering another angle for future chronobiological research in pediatric epilepsy management.
While the SUDEP-7 Inventory is not fully validated in children, it remains the most accessible tool for assessing SUDEP risk in clinical settings. The study’s findings suggest that combining SUDEP-7 scoring with electrophysiological data such as PGES and positional information may offer a more tailored risk profile for pediatric patients.
These insights underscore the need for careful monitoring strategies, particularly for children with drug-resistant epilepsy, and support the integration of EEG-based markers into ongoing clinical risk assessments.
Reference:
Ozbudak P et al. Electrophysiological and clinical markers of SUDEP risk in pediatric epilepsy. Epileptic Disord. 2025. doi: 10.1002/epd2.70057. [Online ahead of print]
