Breathing interruptions after seizures may be a risk factor for unexpected death in epilepsy patients, UTHealth Houston researchers discover

Epilepsy patients who experience breathing interruptions after a seizure may be at a higher risk of sudden unexpected death later in life, according to researchers at UTHealth Houston. 

The study, published in The Lancet, was a collaboration between eight centers in the United States and one in the United Kingdom and led by researchers with the Department of Neurology at McGovern Medical School at UTHealth Houston. 

Over 10 years, the teams sought to identify risk factors for sudden unexpected death in epilepsy, or SUDEP. 

SUDEP is the leading cause of epilepsy-related deaths but was largely an unexplained phenomenon prior to the publication of Wednesday’s research, said senior author Samden Lhatoo, MD, neurologist, professor, John P. and Kathrine G. McGovern Distinguished Chair, and director of the Texas Comprehensive Epilepsy Program at McGovern Medical School. “Three-thousand people in the U.S. die every year from this. Up until now, we didn’t really understand how they died and why they died,” Lhatoo said. “This paper for the first time established that you can identify individual patients at risk, and you can actually characterize the risk markers that will identify people at highest risk of death, in order to put mitigative strategies in place to reduce mortality.” 

In addition to prior incidents of breathing interruptions after seizures, living alone and having three or more seizures the previous year were identified by researchers as SUDEP risk factors.

The study focused on 2,468 children and adults with epilepsy who engaged in long-term cardiorespiratory monitoring at participating epilepsy centers between September 2011 and December 2021. Thirty-eight of the patients died from SUDEP during the study, while another two patients had near-SUDEP events.

The biggest takeaway from the study is the importance of monitoring breathing in epilepsy patients, Lhatoo said. But the findings also pave the way for research that rescues breathing lapses in epilepsy patients.

“This is a major advance for the epilepsy community,” Lhatoo said. 

The research team included co-first authors Manuela Ochoa-Urrea, MD, a resident in the Department of Neurology at McGovern Medical School, and Xi Luo, PhD, an associate professor at UTHealth Houston School of Public Health. Additionally, GQ Zhang, PhD, vice president and chief data scientist at UTHealth Houston and Distinguished Chair in Digital Innovation at the medical school, provided data and informatics expertise to the team.

Other UTHealth Houston coauthors include Nuria Lacuey Lecumberri, MD, PhD; Shirin J. Omidi, MD; Norma Jean Hupp, electroneurodiagnostic technologist; Blanca Talavera De la Esperanza, MD, postdoctoral research fellow; Johnson Hampson, biomedical engineering manager; MR Sandhya Rani, research scientist; Shiqiang Tao, PhD; Xiaojin Li, PhD; Licong Cui, PhD; Jaison Hampson, MBBS, MPH; Chaitanya Ganne, MD, PhD, resident in the Department of Neurology at McGovern Medical School; and Jose-Miguel Yamal, PhD. 

The Department of Biostatistics and Data Science in the School of Public Health was also among the U.S.-based teams that participated in the research. 

In addition to the UTHealth Houston teams, researchers from the National Institute of Neurological Disorders and the Stroke Center for SUDEP Research, Texas Children’s Hospital, the Carver College of Medicine at the University of Iowa, the NYU Grossman School of Medicine, the Sidney Kimmel Medical College at Thomas Jefferson University, the Feinberg School of Medicine at Northwestern University, the University of California Los Angeles, Columbia University, the Cedars-Sinai Medical Center in Los Angeles, and the Queen Square Institute of Neurology at University College London contributed to the study. 

The $27 million project was funded by the National Institutes of Health.