Convulsive seizures are the most consistently reported risk factor for SUDEP. However, the precise mechanisms by which convulsive seizures trigger fatal cardiopulmonary changes are still unclear. Additionally, it is not clear why some seizures cause death when most do not. This article reviews the physiologic changes that occur during and after convulsive seizures and how these may contribute to SUDEP. Seizures activate specific cortical and subcortical regions that can cause potentially lethal cardiorespiratory changes. Clinical factors, including sleep state, medication treatment and withdrawal, positioning and posturing during seizures, and underlying structural or genetic conditions may also affect specific aspects of seizures that may contribute to SUDEP. While seizure control, either through medication or surgical treatment, is the primary intervention that reduces SUDEP risk, unfortunately, seizures cannot be fully controlled despite maximal treatment in a significant proportion of people with epilepsy. Thus specific interventions to prevent adverse seizure-related cardiopulmonary consequences are needed. The potential roles of repositioning/stimulation after seizures, oxygen supplementation, cardiopulmonary resuscitation and clinical treatment options in reducing SUDEP risk are explored. Ultimately, understanding of these factors may lead to interventions that could reduce or prevent SUDEP.

惊厥性癫痫发作是 SUDEP 最一致报道的危险因素。然而，惊厥性癫痫发作引发致命心肺变化的确切机制仍不清楚。此外，尚不清楚为什么有些癫痫发作会导致死亡，而大多数不会。本文回顾了惊厥发作期间和之后发生的生理变化，以及这些变化如何导致 SUDEP。癫痫发作会激活特定的皮层和皮层下区域，从而导致潜在的致命的心肺变化。临床因素，包括睡眠状态、药物治疗和停药、癫痫发作期间的体位和姿势，以及潜在的结构或遗传条件，也可能影响可能导致 SUDEP 的癫痫发作的特定方面。在通过药物或手术治疗控制癫痫发作的同时，是降低 SUDEP 风险的主要干预措施，不幸的是，尽管对很大比例的癫痫患者进行了最大限度的治疗，但仍无法完全控制癫痫发作。因此，需要采取具体的干预措施来预防与癫痫发作相关的不良心肺后果。探讨了癫痫发作后重新定位/刺激、补充氧气、心肺复苏和临床治疗方案在降低 SUDEP 风险方面的潜在作用。最终，了解这些因素可能会导致可以减少或预防 SUDEP 的干预措施。探讨了癫痫发作后重新定位/刺激、补充氧气、心肺复苏和临床治疗方案在降低 SUDEP 风险方面的潜在作用。最终，了解这些因素可能会导致可以减少或预防 SUDEP 的干预措施。探讨了癫痫发作后重新定位/刺激、补充氧气、心肺复苏和临床治疗方案在降低 SUDEP 风险方面的潜在作用。最终，对这些因素的了解可能会导致可以减少或预防 SUDEP 的干预措施。