Sudden unexpected death in epilepsy: a series of witnessed deaths

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Langan Y, Nashef L, and Sander JW (2000) Sudden unexpected death in epilepsy: A series of witnessed deaths. J Neurol Neurosurg Psychiatry 68:2 211–3.

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Abstract: OBJECTIVES: Sudden unexpected death in epilepsy (SUDEP) represents a significant category of mortality in the population with chronic epilepsy. A consistent feature is that most of these deaths are unwitnessed. The aim was to identify witnessed deaths, examine the circumstances, and relate these findings to the proposed mechanisms for SUDEP. METHODS: During the course of case ascertainment for a control study on SUDEP, witnessed deaths were identified and the circumstances examined in detail. Cases were notified by coroners, neurologists, and bereaved families. The findings were related to the proposed mechanisms for SUDEP which include central and obstructive apnoea and cardiac arrhythmia. RESULTS: One hundred and thirty five SUDEP cases have been identified to date, of which 15 were witnessed deaths. Twelve deaths were associated with convulsive seizures, one collapse occurred 5 minutes after a generalised seizure, another collapse occurred after an aura and one patient died while in a probable post ictal state. Witnesses reported that 12 of the 15 cases experienced respiratory difficulty. CONCLUSIONS: Most sudden epilepsy deaths are unwitnessed. Where witnessed most occur in association with a seizure and respiratory compromise is a prominent feature. Positioning or stimulation of respiration may be important in the prevention of these deaths.

Keywords: epilepsy, sudden death, witnessed


  • 15 witnessed deaths were identified from a database of 135 SUDEP cases. Seizure or postictal state were present for all 15 cases. The authors discuss other studies reporting observed SUDEP cases and variable occurrence of seizure in these reports. 12 of 15 cases experienced apparent respiratory difficulty, but the details of some cases are more suggestive of incidental respiratory difficulty, for example, due to collapse in a very cramped space in a respiratory compromise, or loss of consciousness with throat across a bar on a piece of furniture.


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