A review of sudden unexpected death in epilepsy: Prediction of patients at risk

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Hughes JR (2009) A review of sudden unexpected death in epilepsy: Prediction of patients at risk. Epilepsy Behav 14:2 280–7.

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Abstract: This review attempts to provide up-to-date quantitative data from published reports on sudden unexpected death in epilepsy (SUDEP) appearing on Medline and, especially, to provide a means to predict the probability of SUDEP in a given patient. The mean incidence of SUDEP was 1.8/1000, similar to the median of 1.5. The mean standardized mortality ratio was 6.8, and the mean percentage of SUDEP cases among deaths from epilepsy was 16.6. Seventeen risk factors were identified, each given a value according to the number of studies in the literature that specified that condition as a significant risk. The addition of these 17 values then indicated the risk for a given patient. The author calculated these for a group of 91 patients who died of SUDEP and also for 91 live patients. Many of their values for the different risks were significantly different. The sensitivity of these SUDEP values was 71.3%, the specificity 81.8%, and the positive predictive value 84.6%. A discussion includes the question of whether the death in SUDEP is primarily cardiac or pulmonary and the suggestion that it may be either or both in a given patient. The most important risk factor in this study was noncompliance with antiepileptic medication, and the main message of this study to caregivers is that therapeutic drug levels are crucial to avoid SUDEP.

Keywords: Sudden unexpected death in epilepsy, Seizures, Epilepsy, Death, Prediction


  • Careful effort to develop a standardized risk assessment for SUDEP. Classing 91 patients who died of SUDEP and 91 living controls according to 17 risk factors provides a stratification with a positive predictive value of approximately 85%. The single greatest predictor was inappropriate blood level of antiepileptic drugs, indicating an important role for patient/caregiver behavior in prevention, and, by extension, for patient education. Found that death in bed or on the floor was not more likely in SUDEP than in death due to other causes. Potential cardiac and pulmonary etiologies are also reviewed. Extensive bibliography.


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