Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Department of Neurology, McGovern Medical School at UT Health Houston, Houston, Texas, USA.
Ann Clin Transl Neurol. 2024 Sep;11(9):2520-2525. doi: 10.1002/acn3.52153. Epub 2024 Jul 19.
Sudden unexpected death in epilepsy (SUDEP) is a serious threat to individuals with intractable epilepsies, contributing to premature mortality. Understanding the elusive pathophysiological mechanisms of SUDEP, especially in cases without observable terminal events, remains a crucial area for investigation. This study aimed to shed light on the burden of epileptiform activity preceding SUDEP by utilizing an automated electronic seizure diary derived from a sensing-enabled thalamic deep brain stimulator (DBS).
Herein, we present the case of a 57-year-old man afflicted with intractable multifocal epilepsy secondary to cortical dysplasia and encephalomalacia resulting from severe traumatic brain injury. Despite an initial successful resection and subsequent resurgence of seizures necessitating DBS treatment, the patient tragically succumbed to SUDEP.
In-depth analysis of the patient's electronic seizure diary, complemented by data from the sensing-enabled DBS, unveiled a terminal electrographic seizure. Notably, we observed a significant increase in power within specific frequency bands recorded from the thalamus preceding the terminal event. Furthermore, these heightened band power events displayed a discernible temporal clustering pattern, primarily manifesting during specific morning and evening hours. An autopsy conclusively confirmed the diagnosis of definite SUDEP.
This unique case report underscores the feasibility of harnessing thalamic DBS sensing capabilities to monitor seizure burden and, potentially, to tailor interventions aimed at reducing seizure frequency and associated mortality risks.
癫痫性猝死（SUDEP）是一种严重威胁耐药性癫痫患者的疾病，导致过早死亡。理解 SUDEP 难以捉摸的病理生理机制，特别是在没有观察到终末事件的情况下，仍然是一个需要深入研究的重要领域。本研究旨在通过利用感应式丘脑深部脑刺激器（DBS）产生的自动电子癫痫日记来阐明 SUDEP 之前的癫痫样活动负担。
本研究介绍了一位 57 岁男性的病例，他患有皮质发育不良和脑外伤引起的脑软化导致的难治性多灶性癫痫。尽管最初的切除手术成功，随后的癫痫发作需要 DBS 治疗，但患者不幸死于 SUDEP。
对患者电子癫痫日记的深入分析，结合感应式 DBS 的数据，揭示了一次终末期电发作。值得注意的是，我们观察到在终末事件之前，从丘脑记录到的特定频率带内的功率显著增加。此外，这些增强的波段功率事件显示出明显的时间聚类模式，主要在特定的早晨和傍晚出现。尸检最终证实了明确的 SUDEP 诊断。
这个独特的病例报告强调了利用丘脑 DBS 感应能力来监测癫痫负担的可行性，并且可能可以针对降低癫痫发作频率和相关死亡风险的干预措施进行个体化调整。
