Abstracts

Rationale: Background: Sudden unexplained death in epilepsy patients (SUDEP) is diagnosed when death occurs in an epilepsy patient without any identifiable explanation whether or not seizure activity is present. SUDEP is important but the incidence and causes are unknown, especially with regard to how often it is due to seizure activity. It is possible that seizure activity occurs during many cases attributed to SUDEP but it is not reported because a careful history of events at the time of death is not obtained or recorded on death certificates. We sought to examine the frequency of seizure-related death and SUDEP in an epilepsy population. Methods: Cases were identified from retrospective query of an epilepsy patient database to identify deceased patients. Charts were reviewed to determine cause and circumstances of death. No standard assessments were used to determine cause of death but the usual practice in the clinic is to discuss the circumstances of death with the family or an observer present at the time of death and record it in the medical record and database. Results: 50 deaths occurred in 2186 patients followed for an average of 3.48 years (7607 pt-yrs). Death was due to seizure-related aspiration in 5, seizure-related drowning in 2, and possible SUDEP in 4. Death was due to nonseizure-related causes in 23 and unknown cause in 16. All SUDEP patients had autopsy. Seizure activity at the time of death was highly suspected in 3 of 4 SUDEP cases, all of whom were young adults with cardiac findings at autopsy. One child with SUDEP did not have clinical or autopsy findings that could have contributed to her death. Conclusions: Seizure-related death and SUDEP are common in epilepsy patients, occurring at a rate of 1.4 per 1,000 pt/year, most commonly from seizure-related causes such as aspiration. SUDEP is probably often seizure-related even if not witnessed. Careful evaluation of the forensic record and discussion with first-hand observers will often reveal that a seizure likely occurred at time of death. Whether a predisposing cardiac or other abnormality is coincidental or causative will require careful evaluation of more SUDEP cases.