ReviewAutonomic epileptic seizures, autonomic effects of seizures, and SUDEP

Many generalized tonic‐clonic seizures are accompanied by profound autonomic changes. However, autonomic seizures and autonomic status epilepticus can also be seen with specific electroclinical syndromes (Panayiotopoulos syndrome), etiologies, and localizations. Such autonomic symptoms may impact cardiorespiratory function. While it is likely that several factors contribute to SUDEP, further study of both ictal respiratory and cardiac changes and underlying neuroanatomical mechanisms involved in autonomic seizure semiology are likely to provide important data to improve our understanding of the pathophysiology of this devastating condition.This paper will review the association between autonomic symptoms and epileptic seizures and will highlight the work of three young investigators. Drs. Lisa Bateman and Brian Moseley will review their work on cardiorespiratory effects of recorded seizures and how this assists in our understanding of SUDEP. Dr. John Millichap will review autonomic seizures and autonomic dysfunctions related to childhood epilepsy and will discuss the importance of expanded research efforts in this field.This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.

► Autonomic seizures occur in specific syndromes, etiologies and localizations. ► Ictal tachycardia is the most common ictal autonomic manifestation. ► Ictal hypoxemia is common in focal seizures. ► Studying ictal autonomic features may improve our understanding of SUDEP.