ABSTRACT
The mechanisms underlying sudden unexpected death in epilepsy (SUDEP) are unclear and so is our understanding of the final events leading up to SUDEP, although a number of theories have been proposed. These include ictal or postictal respiratory distress, such as central or obstructive apnea or pulmonary edema; ictal cardiac arrhythmias or other ictal or postictal cardiac effects; and ictal cerebral electrical shutdown with generalized electroencephalogram (EEG) suppression (Tomson et al. 2008). A better understanding of the pathophysiology of SUDEP is essential as it can guide the development of preventive strategies as well as effective interventions. Direct observations of SUDEP cases can help us better understand these mechanisms, and the best opportunities for the study of informative cases are those that happen while the patient is in the epilepsy monitoring unit (EMU). This was the incentive for the Mortality in the Epilepsy Monitoring Unit Study (MORTEMUS), which aimed at collecting and reviewing as many cases as possible of cardiorespiratory arrest to identify SUDEP and near-SUDEP cases (Nashef et al. 2012) that have occurred during video-EEG monitoring (Ryvlin et al. 2013). This chapter summarizes the main findings of MORTEMUS.
