Wrist Sensor Reveals Sympathetic Hyperactivity And Hypoventilation Before Probable Sudep

We report a probable sudden unexpected death in epilepsy (SUDEP) in a 20-year-old man wearing a smartwatch that recorded wrist motion via 3-axis accelerometer (ACC) and electrodermal activity (EDA). EDA reflects sympathetic activity without parasympathetic antagonism.1 The smartwatch (Empatica [Milan, Italy] Embrace, with CE Medical clearance from the European Union for seizure detection) issued an alert, received by the caregiver at 8:50 am, indicating a probable convulsive seizure. An adult trained in cardiopulmonary resuscitation (CPR) arrived at 9:05 am, found the patient pulseless, prone, face in pillow with mucus in his mouth, and commenced CPR for 15 minutes without recovery. The family declined autopsy.