Is body position related to the mechanism of death in fatal epilepsy?

Abstract

A retrospective study of 81 epileptic deaths of individuals autopsied at Forensic Science SA between January 1994 and August 2005 revealed 47 males and 34 females aged from 1 to 79 years (mean = 37 years). The most common position of the body when found was prone (N = 52; 64%), followed by supine (N = 17; 21%), seated (N = 7; 8.6%) and side (N = 5; 6%). The most common locations of the bodies were in bed (N = 43; 53%), in the home outside the bedroom (N = 19; 23%), the bedroom (N = 10; 12%) and outdoors (N = 8; 10%). Of the 38 victims who were not in bed, 30 were on a floor and 7 were seated. (In one case the location of the body was not stated although the position was documented.) Of the 30 victims found lying on a floor, 19 (63%) were prone. A significantly greater number of epileptic individuals were found dead lying in a prone compared to a supine position (p<0.001), contrasting dramatically with 50 controls who had died suddenly in their beds of whom only 2 (4%) were prone (p<0.001). The preponderance of deaths in the prone position with the face down would certainly be in keeping with suffocation/asphyxia playing a role in the terminal episode. As SUDEP could result from the integration of a number of mechanisms rather than from the effect of one element in isolation, it is possible that compromise of respiration related to body position might also exacerbate a tendency to lethal cardiac arrhythmia.