Bereavement and Sudden Unexpected Death in Epilepsy

Abstract

Kuller (1996) and Kuller and Lilienfeld (1996) dened the disease process and percentage of cases of sudden and unexpected death in a general forensic autopsy population as follows: heart and/or aorta, 56.1%; respiratory, 14.5%; brain and meninges, 15.8%; digestive/urogenital, 8%; and miscellaneous, 9.5%. Rodin (1968) has stated that life ends earlier, in general, for the person with epilepsy. e mortality ratio is two to three times that found in the general population (Hauser et al. 1980; Kurtzke 1972). As summarized by Wannamaker (1990), death may be the consequence of natural or unnatural causes, such as accidents, homicide, and suicide, that have no relationship to epilepsy. Direct causes of death include status epilepticus, and indirect causes may be head trauma or drowning subsequent to a seizure. When death occurs suddenly and without explanation, the term sudden unexpected unexplained death is used. Sudden is dened as death occurring within 1 h. Leestma (1990) has discussed additional time frames as denitions of sudden because forensic pathologists prefer more precise limits such as less than 1 h, less than 2 h, less than 12 h, and so on. Unexpected notes that death was not imminent. To date, unexpected implies that there are no symptoms or antecedent illness that would predict that death may be imminent. Most persons with epilepsy have many seizures without lethal outcome, and thus it is dicult for the neurologist to ascribe the unexpected, unexplained death of48.1 Clinical Problem of Sudden Death in Persons with Epilepsy 789 48.2 Preclinical Animal Studies Leading to Clinical Studies in Personswith Epilepsy 790 48.2.1 Animal Models of Ouabain-Induced or Coronary Occlusion-InducedArrhythmia and Death 790 48.3 Clinical Studies in Persons with Epilepsy 791 48.4 Criteria for Sudden Unexplained Death in Epileptic Persons 792 48.5 Incidence of Sudden Unexpected Death in Epileptic Persons 793 48.6 Risk Factors for SUDEP 79448.6.1 Low Drug Levels due to Variations in Bioavailability, Drug Metabolism, and/or Compliance? 79448.6.2 Patients with Epilepsy Who Do Not Receive Antiepileptic Drug due to a Dispensing Error 79548.7 Conclusions 796 References 797a patient with epilepsy to a single convulsion. Unexplained is a term that clinicians and research scientists are working to clarify.