Forensic considerations in sudden unexpected death in epilepsy.

Sudden death in epilepsy has recently found its way into both civil and criminal litigation in the United States. Civil cases commonly involve actions or inactions by physicians with respect to antiepileptic drugs (AEDs) alleged to have caused sudden unexpected death in a patient with epilepsy (SUDEP). The context may be discontinuation or change of AEDs or failure to warn of the complication of SUDEP. A common issue in adjudication of such cases is the role of causality of medication type and level in SUDEP. Current knowledge does not permit an accurate assessment of risk for medication discontinuation or poor compliance. Related issues are discussed. In criminal litigation, SUDEP has been accepted by a Federal Court as a cause of death in a crime victim for whom the actions of the accused caused an epileptic state.