Sudden death in epilepsy: An avoidable outcome?

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Lip GY and Brodie MJ (1992) Sudden death in epilepsy: An avoidable outcome? J R Soc Med 85:10 609–11.

Link to Article

Abstract: In a retrospective survey of mortality among the first 1000 unselected patients referred to the Epilepsy Research Unit at the Western Infirmary in Glasgow between 1985 and 1990, a total of 18 deaths were identified. Three patients had committed suicide and one each had died of status epilepticus in hospital, a subdural haematoma and a myocardial infarction. The remaining 12 deaths (67%) were sudden (median age 32 years; range 22-68 years). Poor seizure control and poor compliance with antiepileptic drug therapy were recorded in only three (25%) of these patients. There was a change in antiepileptic drug regimen in five (28%) in the month before death. Only two (17%) underwent postmortem examination. In nine of the 12 patients dying suddenly, the primary cause of death was not listed as epilepsy but as asphyxia (3), aspiration (2) and one each of ischaemic heart disease, myocardial infarction, asystole and drowning (in the bath). 'Status epilepticus' was assumed to have been responsible for the other three deaths, two of which were unwitnessed. Sudden death in people with epilepsy is an entity of great concern. Appropriate death certification and mandatory postmortem examination are essential to provide a truer picture of this neglected phenomenon.

Context

  • Retrospective review of 1,000 patients for a median of 2.3 years identified 18 deaths. Of 12 deaths with no clear precipitant, all were sudden. Only 3 of these patients had poor seizure control or poor medication adherence. Discusses causes of death given on death certificate, such as asphyxia, asystole, and, despite not being witnessed, status epileptipticus. Considers different hypotheses of pathophysiology including possible link with Stokes Adams attacks, arrhythmia-induced syncope with seizures thought to result from reduced cerebral perfusion. Discusses the aspects of sudden death in epileptics most urgently requiring further investigation and calls for better terminology on death certificates.

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