A nationwide survey of the extent of autopsy in sudden unexplained death in epilepsy

Sudden unexplained death in epilepsy is a catastrophic event that requires autopsy for definitive diagnosis. Lack of awareness of sudden unexplained death in epilepsy as an important cause of death in epilepsy has been observed among coroners and pathologists. This survey study of US coroners and medical examiners (MEs) assesses their postmortem examinations of persons with epilepsy who had died suddenly without obvious cause. Analysis of the 510 survey responses shows that pathologists are significantly more likely than nonpathologists to inquire routinely about a history of cardiac disease, remove the brain for examination, or collect blood samples for determinations of anticonvulsant and psychotropic drugs. Urban coroners and MEs are significantly more likely than their nonurban colleagues to remove the brain for examination or collect blood samples for these determinations. Lack of family consent and the cost of autopsy are major reasons for not performing an autopsy of persons with epilepsy. Our study underscores the importance of promoting to all coroners and MEs and to the public the need for thorough autopsy of persons with epilepsy when the cause of death is not obvious.