Electrophysiological and clinical markers of SUDEP risk in pediatric epilepsy

Abstract Objective Sudden unexpected death in epilepsy (SUDEP) is a major cause of epilepsy‐related mortality, especially in patients with drug‐resistant epilepsy. However, pediatric data remain limited, and specific risk assessment tools for children are lacking. This study evaluates the association between peri‐ictal prone positioning, postictal generalized EEG suppression (PGES), and SUDEP‐7 Inventory scores in pediatric patients with epilepsy. Methods A retrospective review was conducted on 273 generalized convulsive seizures (GCS) from 117 pediatric patients who underwent video‐EEG monitoring from 2002 to 2022. We assessed body position during seizures, PGES presence and duration, and SUDEP‐7 Inventory scores. Statistical comparisons were made across PGES‐positive and ‐negative, and prone vs. non‐prone subgroups. Results Prone positioning occurred in 5.86% of seizures, with 91.6% of prone‐onset seizures remaining in the prone position throughout. PGES was present in 50.4% of patients (mean duration: 120.5 s). SUDEP‐7 scores were significantly higher in PGES‐positive patients (mean: 7.04) compared to PGES‐negative (mean: 6.36; p = 0.031). Daytime GCS occurred significantly earlier after sleep onset than night time GCS (53.3 vs. 131.4 minutes; p = 0.001). Significance PGES appears to be a reliable marker associated with higher SUDEP‐7 scores and may indicate increased SUDEP risk in children. While SUDEP‐7 has limitations in pediatric use, it remains the most accessible clinical tool. Integrating EEG and body position metrics could enhance individualized monitoring for pediatric patients at risk.