Laryngospasm, central and obstructive apnea during seizures: Defining pathophysiology for sudden death in a rat model

Highlights • Seizure activity spreads to laryngeal motor neurons to cause laryngospasm. • Laryngospasm results in partial or complete airway occlusion. • Seizure activity changes breathing frequency, amplitude, variability, and can cause central apnea. • Only obstructive apnea was associated with rapid, severe arterial oxygen desaturation, bradycardia, and death. • Sudden death is the result of respiratory arrest during airway obstruction and nearly simultaneous LV dilatation and asystole. • We conclude that sudden death in epilepsy can be the result of seizure induced laryngospasm sufficient to cause obstructive apnea, which leads to respiratory arrest and cardiac asystole within tens of seconds.