Sudden Unexpected Death in Epilepsy

Epilepsy, defined as the tendency for unprovoked seizures, is a common neurologic disease affecting up to 1 in 26 individuals. While the spectrum of comorbidity varies significantly among patients with epilepsy, there is an overall increased mortality risk in this population. Causes of death in individuals with epilepsy include non-epilepsy-related conditions such as suicide, cancers, and cardiovascular disease, as well as epilepsy-related provoked causes, including status epilepticus, anti-seizure drug effects, motor vehicle and bicycle accidents, alcohol withdrawal, aspirational pneumonia, and drowning. Sudden unexpected death in epilepsy (SUDEP) is defined as “death in a patient with epilepsy that is not due to trauma, drowning, status epilepticus, or other known causes but for which there is often evidence of an associated seizure” and represents a leading cause of death in patients with epilepsy. A study on childhood-onset epilepsy long-term mortality showed that out of 60 deaths, 33 (55%) were related to epilepsy, including sudden, unexplained death in 18 subjects (30%). While the risk of sudden, unexplained death was 7% at 40 years. As SUDEP is often unwitnessed, diagnosis is typically made post-mortem. Efforts to distinguish SUDEP from other causes of mortality in epilepsy have led to the sub-categorization of SUDEP into 4 major categories: 1. Definite, 2. Probable, 3. Possible, 4. Unlikely SUDEP  . These categorizations have allowed for a more precise investigation of risks, mechanisms, and preventative strategies. Increasing awareness of SUDEP amongst health professionals and the general public can allow for improved patient counseling and potential modification of risk factors.