Sudden unexpected death in epilepsy

Abstract

Mortality in people with epilepsy is two- to three-times that of the general population. This can be attributed to epilepsy itself (epilepsy-related death) or to the underlying cause of the epilepsy. Sudden unexpected death in epilepsy (SUDEP) is the commonest cause of epilepsy-related death. It is a syndrome where a person with epilepsy dies suddenly and no other cause of death is found. There are frequent reports of persons dying alone in their sleep. It is assumed that death occurs following a seizure but since the deaths are often unwitnessed this is only an assumption. The most important risk factor appears to be poor seizure control. Lately, SUDEP has received much public interest, has been the subject of international forums, ethical debates and comprises part of national guidelines on epilepsy management. Despite its high profile, the evidence for specific risk factors and pathophysiology is still not established. Poor incident case reporting, inaccurate death certification and fewer post-mortem examinations have limited the value of epidemiological data on SUDEP. Here, we review the characteristics of SUDEP, its likely risk factors, mechanisms and differential diagnosis, and consider possible strategies for prevention. We also explore the discussion of SUDEP with patients and the management of relatives of SUDEP patients.

The relationship between sleep and epilepsy: Evidence from clinical trials and animal models

“…Taken together, these results indicate a strong relationship between epilepsy and OSAS, in which the sleep fragmentation and chronic sleep deprivation caused by OSAS may facilitate the appearance of IEDs and the occurrence of seizures. This important relationship deserves more investigation because approximately 7.5% to 17% of the population with epilepsy dies without any clear cause, where this may be associated with uncontrolled seizures [83][84][85]. The pathological mechanisms responsible for this phenomenon, known as Sudden Expected Death in Epilepsy (SUDEP), are not well understood [86].…”

Difficulties in Treatment and Management of Epilepsy and Challenges in New Drug Development

“…Mortality in epileptic patients is two- to three-times that of the general population, and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death [25,26,27]. SUDEP is defined as a non-traumatic and non-drowning death in patients with epilepsy that is sudden, unexpected, witnessed or unwitnessed, and with or without evidence of a seizure [25].…”

Seizures in patients with low-grade gliomas — incidence, pathogenesis, surgical management, and pharmacotherapy

“…Age-related mortality is increased two-to threefold in epileptics. At least some cases are caused by seizures and not by the underlying disease [51]. Finally, there is some evidence to suggest that epileptics will benefit from early treatment and respond with better seizure control [66,71].…”

“…Even among patients with epilepsy without an underlying neoplastic condition, there is a considerable excess mortality [51]. Casuistic evidence suggests that seizures rank prominently among the treatable causes of unfavorable outcomes after brain tumor surgery [31].…”