Sudden unexpected death in epilepsy

Epilepsy is one of the most frequent and oldest-known neurological disorders. While most people with epilepsy lead a normal life, their expected lifespan is 2-10 years shorter than that of their peers in general population, depending on epilepsy type. Mortality rate among persons with epilepsy is twice as high as in healthy people. Sometimes, they suffer sudden death from unclear reasons (sudden unexpected death in epilepsy, SUDEP). In most cases, SUDEP affects people aged 20-40. Most common causes of death in adults with epilepsy include: ischaemic heart disease, cerebral vascular disease, malignancy, respiratory tract infections, trauma and suicide. They account for nearly 80% of all deaths. Patients often die from causes which have led to the development of their epilepsy. Mortality rate in children with epilepsy may be even 90-fold higher than in their non-epileptic peers. Reliability of epidemiologic data concerning SUDEP is limited due to poor reporting of such cases and small number of post-mortem exams performed in these patients. In view of the relatively large population of patients with epilepsy, SUDEP becomes an important medical problem. Data have raised much interest among epileptologists and encouraged studies searching for causes, potential risk factors and possible preventive measures. This paper reviews the SUDEP phenomenon, possible risk factors, pathomechanisms associated therewith and available preventive strategies.