Abstract
Sudden unexpected death in epilepsy (SUDEP) accounts for up to 17% of deaths in epileptic patients. These
unexplained deaths may be precipitated by laryngospasm, tight closure of the laryngeal inlet that causes
airway obstruction. Seizures cause a wide range of respiratory changes, and laryngospasm has been
observed in patients with ictal respiratory distress. Moreover, using a model of anesthetized rats treated
with urethane and kainate, we recently demonstrated that seizure-induced laryngospasm initiates a
sequence of obstructive apnea, arterial oxygen desaturation, bradycardia, respiratory arrest, and, without
intervention, death. Here, we propose to test the hypothesis that laryngospasm is the proximal cause of
death in SUDEP cases by using a model of AWAKE, UNANESTHETIZED mice that are prone to dying from
audiogenic seizures. Our study population will comprise two cohorts of mice with custom-made T-shaped
tubes implanted in the trachea while preserving recurrent-laryngeal-nerve function. In the experimental
group, the tube's percutaneous side arm will be left open to provide an alternative airway; in the control
group, the side arm will be closed to limit airflow to the normal airway. We predict that the experimental
mice will survive audiogenic seizures because the alternative airway will allow air to bypass laryngospasm;
the control mice, in contrast, will die from the seizures. The results of this study will provide additional
evidence for the contribution of ictal laryngospasm to death. In particular, this animal model more closely
resembles typical patients because of the absence of anesthetic and epileptogenic drugs. In addition, this
study has direct application to the clinical arena in which skilled upper-airway management during seizures
may be a key component to preventing patient deaths. Finally, the results will guide the development of
resuscitative and preventative strategies that can be translated to patients at risk for sudden death in
epilepsy.