Research Spotlight: Understanding Sudden Unexpected Death in Epilepsy
Epilepsy is the source of one of the biggest mysteries in neurology. While most people survive seizures, a small number of seizures lead to sudden death. Ian Wenker, PhD, hopes to solve the mystery of sudden unexpected death in epilepsy (SUDEP).
Wenker was drawn to his research because of the brain’s complexity. “The brain is the one organ responsible for the most diverse set of functions,” he says. “The brain coordinates movement, senses the world, creates memories and emotions, and produces consciousness.”
Early in his career, Wenker developed an interest in how the brain controls breathing, which led to his epilepsy research. He shares more about his research in this video and Q&A.
Ian Wenker, PhD, on Researching Sudden Death in Epilepsy
What I love is coming in every day here at UVA. It's such a creative process doing research, and I love sharing it with the people I work with, such smart and passionate people here at UVA, both that work for me and those I collaborate with across campus. I also enjoy engaging with the community. I work with a number of patient populations across the country, where they give me a lot of feedback on what we're doing and they're excited about the work we do, which just reinvigorates me to do all that we can every day. My name is Ian Wenker. I'm an assistant professor in the anesthesiology department. My overall research focus for years has been understanding how the brain controls automatic processes that we all do, like breathing, cardiovascular function, heart rate, things like that. And right now, a big focus of the lab is trying to understand how the brain contributes to what's called sudden unexpected death in epilepsy. So people with epilepsy-unfortunately some fraction of them- will experience this where they're found deceased and we don't understand yet why. And so in the lab, we’re trying to understand what the mechanisms of that are. And it's still early stages, but we've been making good progress and we're hopeful to make an impact. So our work on SUDEP, or sudden unexpected death in epilepsy is basic in that we're trying to understand mechanisms that create this fatal complication in epilepsy. And we're hopeful that once we understand these mechanisms, we’ll be able to translate them into therapies so that the people who are taking care of those with epilepsy will be able to intervene and save their life, and this will allow them to hopefully sleep better at night and be able to better take care of their loved ones.
What are you working on right now?
My lab’s current research focuses on understanding the mechanisms of SUDEP and how seizures become fatal. That’s perhaps our most intriguing question. Most people survive seizures, but it is not clear what drives any seizure to impair vital functions. We are examining specific neuronal groups in the brainstem that we think are activated during particularly severe seizures, leading to respiratory arrest and possibly SUDEP.
The follow-up question then is why does breathing not recover after a respiratory arrest caused by a seizure? To answer this question, we are examining the impact of seizures on the brainstem's natural ability to detect elevated carbon dioxide levels and regulate breathing. We have mouse models in which seizures can be induced by playing a tone. We can then assess the mouse’s respiratory reflex. We have found this reflex is suppressed and we’re beginning to examine how this occurs.
What are the most intriguing potential clinical applications of your work on SUDEP?
Identifying certain brain regions and neurons that drive respiratory arrest during and after seizures could provide targets for treatment. Stimulation devices could be implanted in these regions to prevent fatal pauses in breathing (apneas). These approaches are already used to treat diseases like Parkinson’s. With continued advances in seizure detection and wearable technology, this could become a genuinely viable therapeutic option.
What do you wish more people knew about your area of research?
I wish they knew what I didn’t know until a few years ago. Epilepsy is actually a very common condition, affecting more than 1% of the general population, and SUDEP is rare but devastating.
What recent discovery has impacted the way you think?
Brian Dlouhy’s work at the University of Iowa has been quite enlightening. He has demonstrated that stimulation of certain parts of the amygdala in humans can produce long-lasting apneas that people don’t notice. His work indicates that abnormal brain activation during seizures could be responsible for breathing dysfunction seen in situations such as SUDEP.
What made you choose UVA Health as the place to do your research?
I came to UVA for the opportunity to work on this current epilepsy project. My previous work involved brainstem control of breathing and cardiovascular function, but I was new to the field of epilepsy. Epilepsy and basic neuroscience research here at UVA are excellent. Perhaps more importantly, my colleagues here have been amazing collaborators and educators. I could not do this research without them.
