Sudden unexpected death in epilepsy: Impact, mechanisms, and prevention

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Jehi L and Najm IM (2008) Sudden unexpected death in epilepsy: Impact, mechanisms, and prevention. Cleve Clin J Med 75 Suppl 2: S66–70.

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Abstract: Patients with refractory epilepsy face an elevated risk of sudden death, with rates as high as 1% per year. This phenomenon, known as sudden unexpected death in epilepsy (SUDEP), is believed to be a seizure-related occurrence, but the exact underlying mechanisms are uncertain. Both pulmonary and cardiac pathophysiologies have been proposed. The cardiac mechanism of greatest interest is the precipitation of arrhythmias by seizure discharges via the autonomic nervous system. SUDEP prevention has centered on effective seizure control, and epilepsy surgery has reduced SUDEP incidence in a number of studies. Additional prophylaxis methods are needed, however, for the large number of patients with treatment-refractory epilepsy. Future research should aim to clarify whether the association between seizures and autonomic dysfunction and cardiac arrhythmias extends to a demonstrable cardiac mechanism for SUDEP.



  • Discussion of pathogenesis of SUDEP with presentation of very brief case vignettes focusing on links between seizure activity and arrhythmias potentially incited by altered autonomic input. One case involved a patient with longstanding epilepsy who ‘had a myocardial infarction’ while being transported in the hospital and was successfully rescuscitated, while another had a dramatic reduction in seizures after temporal lobectomy, discontinued medications, and was found dead one year later. EEG/ECG comparisons are also presented.


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