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Concept
Sudden unexpected death in epilepsy
Summary
Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy. It is defined as the sudden and unexpected, non-traumatic and non-drowning death of a person with epilepsy, without a toxicological or anatomical cause of death detected during the post-mortem examination.
While the mechanisms underlying SUDEP are still poorly understood, it is possibly the most common cause of death as a result of complications from epilepsy, accounting for between 7.5 and 17% of all epilepsy-related deaths and 50% of all deaths in refractory epilepsy. The causes of SUDEP seem to be multifactorial and include respiratory, cardiac and cerebral factors as well as the severity of epilepsy and seizures. Proposed pathophysiological mechanisms include seizure-induced cardiac and respiratory arrests.
Among epileptics, SUDEP occurs in about 1 in 1,000 adults and 1 in 4,500 children annually. Rates of death as a result of prolonged seizures (status epilepticus) are not classified as SUDEP.
The overarching term SUDEP can be subdivided into four different categories: Definite, Probably, Possible, and Unlikely.
Definite SUDEP: a non-traumatic and non-drowning death in an individual with epilepsy, without a cause of death after postmortem examination.
Definite SUDEP Plus: includes the presence of a concomitant condition other than epilepsy, where death may be due to the combined effects of both epilepsy and the other condition.
Probably SUDEP: all the same criteria for Definite SUDEP are met, but no postmortem examination is performed.
Possible SUDEP: insufficient information is available regarding the death, with no postmortem examination.
Unlikely SUDEP: an alternate cause of death has been determined, ruling out the possibility of SUDEP being the cause.
Consistent risk factors include:
Severity of seizures, increased refractoriness of epilepsy and presence of generalized tonic–clonic seizures: the most consistent risk factor is an increased frequency of tonic–clonic seizures.
Poor compliance.
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