Central apnea at complex partial seizure onset

Sudden Unexpected Death in Epilepsy (SUDEP) is the most common cause of epilepsy related mortality in treatment resistant epilepsy. Most SUDEPs occur after one or more seizure(s) during sleep. Nocturnal seizures may go unrecognized. Respiratory depression in the peri-ictal period is one of the primary potential causes of SUDEP. Ictal and postictal apnea is often overlooked because it is not routinely assessed, but appears common and has been a recent focus of SUDEP research. We report a 37 year-old man who had central apnea as the initial manifestation of partial complex seizures associated with oxygen desaturation. This important pathophysiological consequence of a nocturnal complex seizure was identified by respiratory monitoring during a combined video EEG and sleep study. Diagnostic and therapeutic implications are discussed.