nearSUDEP

NearSUDEP is a term used in epilepsy research and clinical practice to describe a life-threatening seizure-related event that closely resembles sudden unexpected death in epilepsy (SUDEP) but ends with the survivor remaining alive. The designation is typically applied when a patient experiences a seizure and a period of respiratory or autonomic compromise that would have been fatal without timely resuscitation, rapid medical intervention, or spontaneous recovery.

Events described as near-SUDEP often involve prolonged central apnea, hypoxemia, bradycardia or transient arrhythmias, and postictal suppression of consciousness. They commonly follow generalized tonic-clonic seizures, especially nocturnal or poorly controlled seizures. The pathophysiology overlaps with SUDEP and is thought to include impaired brainstem autonomic regulation, airway obstruction or laryngospasm, and diminished arousal after a seizure, leading to a critical period of respiratory or cardiovascular failure.

Near-SUDEP is not a distinct medical diagnosis with formal criteria; rather, it is a descriptive term used in case reports and reviews to capture events that reveal the vulnerability of the cardiorespiratory system in epilepsy. Its identification emphasizes the importance of optimal seizure control, medication adherence, nocturnal supervision, and ready access to emergency care, including prompt rescue medications and CPR when required.

Because near-SUDEP has limited standardized data, estimates of incidence are not established. The concept supports research into SUDEP mechanisms and prevention, and it encourages clinicians to document near-fatal events to improve understanding of risk factors and timing. Prevention strategies focus on reducing seizure burden, monitoring high-risk patients, and ensuring rapid response to seizures.