Premature deaths in persons with seizure disorders – Subtherapeutic levels of anticonvulsant drugs in postmortem blood specimens
Bowerman DL, Levisky JA, Urich RW, and Wittenberg PH (1978) Premature deaths in persons with seizure disorders – Subtherapeutic levels of anticonvulsant drugs in postmortem blood specimens. J Forensic Sci 23:3 522–6.
Abstract: Eleven autopsy cases from a Colorado coroner's service are presented in which postmortem levels of anticonvulsant drugs were subtherapeutic. Scene investigation or medical history, or both, revealed evidence of epilepsy in all eleven cases. Five of the deaths (three drowning and two with aspiration of gastric contents) occurred during a suspected seizure. The six remaining deaths were attributed to asphyxia associated with terminal seizures. Because anatomic evidence of epilepsy is often minimal and nonspecific, the authors think that levels of anticonvulsant drugs should be determined in cases of sudden unexpected death with a history of epilepsy. It is probable that these eleven deaths were preventable with better patient motivation and compliance with the physicians' orders. Many epileptic patients fail to take their medications as directed because of the undesired side effects. Lower doses of anticonvulsant drugs could reduce the degree and number of unwanted side effects and encourage patient compliance. Therefore, careful monitoring of serum anticonvulsant levels during the life of the patient might permit lower but still adequate drug levels with fewer adverse effects and hence encourage the epileptic to comply with the doctor's orders, take his medication, and live.
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Context
- Report of low postmortem AED levels in 11 epilepsy patients. 6 deaths had no clear precipitant and were attributed to asphyxia. Highlights the desirability of frequent monitoring of AED levels to ensure the lowest effective dosing is achieved to minimize side effects and increase adherence. For discussion of the evidence for and against a role for subtherapeutic AED in SUDEP see the annotation at Tomson et al.