Abstract
Epilepsy is associated with a higher rate of premature death than the general population, and the commonest cause of epilepsy mortality is sudden unexpected death in epilepsy (SUDEP). It is difficult to quantify because of the variable reporting of this cause of death. Death occurs due to autonomic deregulation of cardio-respiratory pathways as a result of seizures. Measures to reduce cardio-respiratory dysfunction are discussed together with the importance of seizure control in preventing SUDEP. The role of seizure detection devices, antiepileptic drugs and the importance of providing information about SUDEP to people with epilepsy are highlighted. There is increasing interest in SUDEP and some current initiatives are discussed.
Highlights
Epilepsy is the most common serious neurological condition, affecting almost 60 million people worldwide [1]
Page 3 of 6, 502 papers is currently being carried out by an international group convened by the American Association of Neurologists (AAN) to review all available data and preliminary results from this review show the incidence of sudden unexpected death in epilepsy (SUDEP) to depend on type and severity of epilepsy with an overall incident rate range for the general epilepsy population, including children and adults, estimated at 0.7–1.5 per 1000 patient-years, inclusive of refractory patients
A reanalysis of this study showed that there are differences between high-frequency heart rate variability (HRV) [30] and a further study of 19 individuals showed an association between HRV and SUDEP risk [31] and this association with progressive deterioration of HRV was noted in a case report [32]
Summary
Sudden unexpected death in epilepsy (SUDEP) is an uncommon but tragic consequence of epilepsy. SUDEP has received considerable examination over the last 10 years with a revision of the definition, an attempt to more accurately estimate the true incidence, a better understanding of the mechanisms and risk factors leading to death, and how the risk of SUDEP is discussed with patients and families. Significant funding is currently available from the National Institute for Health with SUDEP being the subject of a Centre without Walls call in 2014. This followed the research recommendations of The National Institute for Health/National Institute for Neurological Disease and Stroke Workshop on SUDEP in 2011 [4]. The mechanisms of SUDEP are described, and how improved understanding of why SUDEP occurs may lead to effective risk reduction strategies and how the risk may be reduced
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