Sudden unexpected death in epilepsy

Sudden unexpected death in epilepsy
Classification and external resources

Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy.[1] It is defined as the sudden and unexpected, non-traumatic and non-drowning death of a person with epilepsy, without a toxicological or anatomical cause of death detected during the post-mortem examination.[2][3] While the mechanisms underlying SUDEP are still poorly understood, it is possibly the most common cause of death as a result of complications from epilepsy, accounting for between 7.5 and 17% of all epilepsy-related deaths[2] and 50% of all deaths in refractory epilepsy.[4][5] The causes of SUDEP seem to be multifactorial[2] and include respiratory, cardiac and cerebral factors, as well as the severity of epilepsy and seizures.[5] Proposed pathophysiological mechanisms include seizure-induced cardiac and respiratory arrests.[4] Instances of death as a result of prolonged seizures (status epilepticus) are not classified as SUDEP.[6]

Risk factors

Consistent risk factors include:


The mechanisms underlying SUDEP are not well understood but probably involve several pathophysiological mechanisms and circumstances. The most commonly involved are seizure-induced hypoventilation and cardiac arrhythmias but different mechanisms may be involved in different individuals, and more than one mechanism may be involved in any one individual.[10]


The lack of generally recognized clinical recommendations available are a reflection of the dearth of data on the effectiveness of any particular clinical strategy,[10] but on the basis of present evidence, the following may be relevant:



  1. Ryvlin, P; Nashef, L; Tomson, T (May 2013). "Prevention of sudden unexpected death in epilepsy: a realistic goal?". Epilepsia. 54 Suppl 2: 23–8. doi:10.1111/epi.12180. PMID 23646967.
  2. 1 2 3 4 5 6 Terra, VC; Cysneiros, R; Cavalheiro, EA; Scorza, FA (Mar 2013). "Sudden unexpected death in epilepsy: from the lab to the clinic setting.". Epilepsy & behavior : E&B. 26 (3): 415–20. doi:10.1016/j.yebeh.2012.12.018. PMID 23402930.
  3. Nashef, L; So, EL; Ryvlin, P; Tomson, T (Feb 2012). "Unifying the definitions of sudden unexpected death in epilepsy.". Epilepsia. 53 (2): 227–33. doi:10.1111/j.1528-1167.2011.03358.x. PMID 22191982.
  4. 1 2 3 4 5 Tolstykh, GP; Cavazos, JE (Mar 2013). "Potential mechanisms of sudden unexpected death in epilepsy.". Epilepsy & behavior : E&B. 26 (3): 410–4. doi:10.1016/j.yebeh.2012.09.017. PMID 23305781.
  5. 1 2 3 4 5 6 7 8 9 Devinsky, Orrin (10 November 2011). "Sudden, Unexpected Death in Epilepsy". New England Journal of Medicine. 365 (19): 1801–1811. doi:10.1056/NEJMra1010481.
  6. Tomson T, Nashef L, Ryvlin P (November 2008). "Sudden unexpected death in epilepsy: current knowledge and future directions". Lancet Neurology. 7 (11): 1021–31. doi:10.1016/S1474-4422(08)70202-3. PMID 18805738.
  7. Maguire, M. J.; Jackson, C. F.; Marson, A. G.; Nolan, S. J. (2016). "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews. 7: CD011792. doi:10.1002/14651858.CD011792.pub2. PMID 27434597. |chapter= ignored (help)
  8. 1 2 3 4 5 6 Surges, R; Sander, JW (Apr 2012). "Sudden unexpected death in epilepsy: mechanisms, prevalence, and prevention.". Current opinion in neurology. 25 (2): 201–7. doi:10.1097/WCO.0b013e3283506714. PMID 22274774.
  9. Nobili, L; Proserpio, P; Rubboli, G; Montano, N; Didato, G; Tassinari, CA (Aug 2011). "Sudden unexpected death in epilepsy (SUDEP) and sleep.". Sleep medicine reviews. 15 (4): 237–46. doi:10.1016/j.smrv.2010.07.006. PMID 20951616.
  10. 1 2 3 4 5 6 Shorvon, S; Tomson, T (Dec 10, 2011). "Sudden unexpected death in epilepsy.". Lancet. 378 (9808): 2028–38. doi:10.1016/S0140-6736(11)60176-1. PMID 21737136.
  11. So, N. K.; Sperling, M. R. (31 July 2007). "Ictal asystole and SUDEP". Neurology. 69 (5): 423–424. doi:10.1212/01.wnl.0000268698.04032.bc.
  12. Schuele, SU; Bermeo, AC; Alexopoulos, AV; Locatelli, ER; Burgess, RC; Dinner, DS; Foldvary-Schaefer, N (Jul 31, 2007). "Video-electrographic and clinical features in patients with ictal asystole.". Neurology. 69 (5): 434–41. doi:10.1212/01.wnl.0000266595.77885.7f. PMID 17664402.
  13. Ryvlin, P; Cucherat, M; Rheims, S (Nov 2011). "Risk of sudden unexpected death in epilepsy in patients given adjunctive antiepileptic treatment for refractory seizures: a meta-analysis of placebo-controlled randomised trials.". Lancet neurology. 10 (11): 961–8. doi:10.1016/S1474-4422(11)70193-4. PMID 21937278.
  14. Hesdorffer, DC; Tomson, T (Feb 2013). "Sudden unexpected death in epilepsy. Potential role of antiepileptic drugs.". CNS Drugs. 27 (2): 113–9. doi:10.1007/s40263-012-0006-1. PMID 23109241.
  15. Surges, R; Thijs, RD; Tan, HL; Sander, JW (Sep 2009). "Sudden unexpected death in epilepsy: risk factors and potential pathomechanisms.". Nature reviews. Neurology. 5 (9): 492–504. doi:10.1038/nrneurol.2009.118. PMID 19668244.
  16. eMedicine - Sudden Unexpected Death in Epilepsy : Article by Shahin Nouri
  17. "Epilepsy Facts". Citizens United for Research in Epilepsy. Retrieved 18 March 2014.
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