Sudden unexplained death in epilepsy: Epidemiology and risk factors

The risk of sudden unexplained death in epilepsy (SUDEP) is in general about 1 in 3,000 personyears, but the risk is disturbingly high at 1 in about 100 person-years if epilepsy is poorly controlled. The type of epilepsy does infl uence the degree of SUDEP risk, as it has been consistently shown by many studies that generalized convulsive seizures carry the highest risk, and higher frequency of generalized convulsive seizures is associated with greater SUDEP risk. The underlying mechanism of the sudden death is still unknown. Peri-ictal cardio-respiratory dysfunction has been a prime suspect in causing the sudden death, but autonomic dysfunction and genetic factors may in the future be shown to predispose some persons to SUDEP. Recent animal studies suggest that insufficient brainstem serotonergic activity may play a role in causing SUDEP. This fi nding raises the potential role of SSRI medications in preventing SUDEP. For now, SUDEP prevention should focus on patient and family education and counseling about the nature of the condition and its currently known ri skfactors. Persons with epilepsy should be encouraged to strive for the best seizure control possible, especially when their seizures are generalized convulsive in type.