Forensic population study of sudden unexplained death in epilepsy in children and young people during the period 1991–2021

Abstract

IntroductionSudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in young epileptic patients. The objective of the work is to analyse its frequency and clinical–pathological characteristics as a cause of sudden death in epileptics under 35 years of age. MethodsRetrospective population study of all SUDEP in people aged 1–35 years in Bizkaia (period 1991–2021) and Seville (2004–2021) investigated in the Forensic Pathology Services (FPS). In each case, a complete autopsy was carried out with histopathological and toxicological studies, and review of clinical and circumstantial data. Data from the Mortality Registry for deaths by epilepsy were examined. Results101 deaths due to epilepsy were registered in the Mortality Registries and 46 SUDEP cases in the FPS, representing 6% of forensic sudden deaths in this age population. A high frequency of post-traumatic epilepsy cases (n=5), brain abnormalities (n=5), or epilepsy associated to developmental disorders (n=4) or mental retardation (n=3) was observed. The toxicological analysis was positive in 75%, highlighting the presence of antiepileptic drugs (n=26). Illegal drugs were detected in 5 young people, mainly cocaine (n=3). Death was unwitnessed in most subjects (85%) and occurred at night (n=63%) while sleeping. ConclusionsSUDEP in children and young people is infrequent, however, it is an important cause of mortality in epileptics. Although the mechanisms are not well understood, it is recommended to strengthen the medical control of epilepsy in youth, mainly in patients with post-traumatic or post-surgical epilepsy or in those who have associated developmental disorders or mental retardation.