Fig. 9

Summary schematic of possible outcomes mediated by autonomic overactivity associated with seizures. As described in Fig. 2, the majority of seizures will terminate on their own and permit a spontaneous recovery of autonomic derangements. As highlighted in Fig. 3, asystole will terminate the seizure and lead to the same kind of recovery once the seizure ends. Ventricular fibrillation is one path to death (Fig. 4), but this is a difficult condition to achieve and actually gets harder as the heart dilates with repeated seizures [72]. The cause of death that we believe is the most likely, given that laryngospasm is a feature of every convulsive seizure, is seizure-induced laryngospasm sufficient to cause obstructive apnea. The apneic condition can persist beyond the end of the seizure (the severe bradycardia and poor ejection fraction will lead to decreased brain blood flow and terminate the seizure). Once the point of respiratory arrest is reached, relaxation of the laryngospasm or artificially opening the airway will not be sufficient for resuscitation. There is clearly a window of opportunity for cardiopulmonary resuscitation (CPR) to resuscitate patients at this point, but resuscitation depends on how quickly CPR can be applied [3]. As a preventative measure, the best prevention remains good control of seizures. As interventions, the opportunity for resuscitation after VF or laryngospasm is short. Attention to differentiating between these two possibilities will save additional time. Critically, access to an animal model such as ours will permit the exploration of additional preventative or interventional approaches