Skip to main content
Journal of the Royal Society of Medicine logoLink to Journal of the Royal Society of Medicine
. 1992 Oct;85(10):609–611.

Sudden death in epilepsy: an avoidable outcome?

G Y Lip 1, M J Brodie 1
PMCID: PMC1293687  PMID: 1433037

Abstract

In a retrospective survey of mortality among the first 1000 unselected patients referred to the Epilepsy Research Unit at the Western Infirmary in Glasgow between 1985 and 1990, a total of 18 deaths were identified. Three patients had committed suicide and one each had died of status epilepticus in hospital, a subdural haematoma and a myocardial infarction. The remaining 12 deaths (67%) were sudden (median age 32 years; range 22-68 years). Poor seizure control and poor compliance with antiepileptic drug therapy were recorded in only three (25%) of these patients. There was a change in antiepileptic drug regimen in five (28%) in the month before death. Only two (17%) underwent postmortem examination. In nine of the 12 patients dying suddenly, the primary cause of death was not listed as epilepsy but as asphyxia (3), aspiration (2) and one each of ischaemic heart disease, myocardial infarction, asystole and drowning (in the bath). 'Status epilepticus' was assumed to have been responsible for the other three deaths, two of which were unwitnessed. Sudden death in people with epilepsy is an entity of great concern. Appropriate death certification and mandatory postmortem examination are essential to provide a truer picture of this neglected phenomenon.

Full text

PDF
611

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Annegers J. F., Elveback L. R., Labarthe D. R., Hauser W. A. Ischemic heart disease in patients with epilepsy. Epilepsia. 1976 Mar;17(1):11–14. doi: 10.1111/j.1528-1157.1976.tb03376.x. [DOI] [PubMed] [Google Scholar]
  2. Annegers J. F., Hauser W. A., Shirts S. B. Heart disease mortality and morbidity in patients with epilepsy. Epilepsia. 1984 Dec;25(6):699–704. doi: 10.1111/j.1528-1157.1984.tb03480.x. [DOI] [PubMed] [Google Scholar]
  3. Blumhardt L. D., Smith P. E., Owen L. Electrocardiographic accompaniments of temporal lobe epileptic seizures. Lancet. 1986 May 10;1(8489):1051–1056. doi: 10.1016/s0140-6736(86)91328-0. [DOI] [PubMed] [Google Scholar]
  4. Boesen F., Andersen E. B., Jensen E. K., Ladefoged S. D. Cardiac conduction disturbances during carbamazepine therapy. Acta Neurol Scand. 1983 Jul;68(1):49–52. doi: 10.1111/j.1600-0404.1983.tb04814.x. [DOI] [PubMed] [Google Scholar]
  5. Bowerman D. L., Levisky J. A., Urich R. W., Wittenberg P. H. Premature deaths in persons with seizure disorders--subtherapeutic levels of anticonvulsant drugs in postmortem blood specimens. J Forensic Sci. 1978 Jul;23(3):522–526. [PubMed] [Google Scholar]
  6. Brown S. W., Mawer G. E., Lawler W., Taylor D. C., Shorvon S., Betts T. A., Noronha M. J., Richens A., Chadwick D., Besag F. M. Sudden death and epilepsy. Lancet. 1990 Mar 10;335(8689):606–607. doi: 10.1016/0140-6736(90)90390-q. [DOI] [PubMed] [Google Scholar]
  7. Dasheiff R. M., Dickinson L. J. Sudden unexpected death of epileptic patient due to cardiac arrhythmia after seizure. Arch Neurol. 1986 Feb;43(2):194–196. doi: 10.1001/archneur.1986.00520020080028. [DOI] [PubMed] [Google Scholar]
  8. Falconer B., Rajs J. Post-mortem findings of cardiac lesions in epileptics: a preliminary report. Forensic Sci. 1976 Jul-Aug;8(1):63–71. doi: 10.1016/0300-9432(76)90048-0. [DOI] [PubMed] [Google Scholar]
  9. Goodman J. H., Homan R. W., Crawford I. L. Kindled seizures elevate blood pressure and induce cardiac arrhythmias. Epilepsia. 1990 Sep-Oct;31(5):489–495. doi: 10.1111/j.1528-1157.1990.tb06096.x. [DOI] [PubMed] [Google Scholar]
  10. Hamilton D. V. Carbamazepine and heart block. Lancet. 1978 Jun 24;1(8078):1365–1365. doi: 10.1016/s0140-6736(78)92442-x. [DOI] [PubMed] [Google Scholar]
  11. Hauser W. A., Annegers J. F., Elveback L. R. Mortality in patients with epilepsy. Epilepsia. 1980 Aug;21(4):399–412. doi: 10.1111/j.1528-1157.1980.tb04088.x. [DOI] [PubMed] [Google Scholar]
  12. Hirsch C. S., Martin D. L. Unexpected death in young epileptics. Neurology. 1971 Jul;21(7):682–690. doi: 10.1212/wnl.21.7.682. [DOI] [PubMed] [Google Scholar]
  13. Iivanainen M., Lehtinen J. Causes of death in institutionalized epileptics. Epilepsia. 1979 Oct;20(5):485–491. doi: 10.1111/j.1528-1157.1979.tb04830.x. [DOI] [PubMed] [Google Scholar]
  14. Jay G. W., Leestma J. E. Sudden death in epilepsy. A comprehensive review of the literature and proposed mechanisms. Acta Neurol Scand Suppl. 1981;82:1–66. [PubMed] [Google Scholar]
  15. Keilson M. J., Hauser W. A., Magrill J. P., Goldman M. ECG abnormalities in patients with epilepsy. Neurology. 1987 Oct;37(10):1624–1626. doi: 10.1212/wnl.37.10.1624. [DOI] [PubMed] [Google Scholar]
  16. Kraras C. M., Tumer N., Lathers C. M. The role of enkephalins in the production of epileptogenic activity and autonomic dysfunction: origin of arrhythmia and sudden death in the epileptic patient? Med Hypotheses. 1987 May;23(1):19–31. doi: 10.1016/0306-9877(87)90176-9. [DOI] [PubMed] [Google Scholar]
  17. Larkin J. G., Herrick A. L., McGuire G. M., Percy-Robb I. W., Brodie M. J. Antiepileptic drug monitoring at the epilepsy clinic: a prospective evaluation. Epilepsia. 1991 Jan-Feb;32(1):89–95. doi: 10.1111/j.1528-1157.1991.tb05618.x. [DOI] [PubMed] [Google Scholar]
  18. Leestma J. E., Walczak T., Hughes J. R., Kalelkar M. B., Teas S. S. A prospective study on sudden unexpected death in epilepsy. Ann Neurol. 1989 Aug;26(2):195–203. doi: 10.1002/ana.410260203. [DOI] [PubMed] [Google Scholar]
  19. Lipka L. J., Lathers C. M. Psychoactive agents, seizure production, and sudden death in epilepsy. J Clin Pharmacol. 1987 Mar;27(3):169–183. doi: 10.1002/j.1552-4604.1987.tb02180.x. [DOI] [PubMed] [Google Scholar]
  20. Lund A., Gormsen H. The role of antiepileptics in sudden death in epilepsy. Acta Neurol Scand. 1985 Oct;72(4):444–446. doi: 10.1111/j.1600-0404.1985.tb00898.x. [DOI] [PubMed] [Google Scholar]
  21. Lühdorf K., Jensen L. K., Plesner A. M. Epilepsy in the elderly: life expectancy and causes of death. Acta Neurol Scand. 1987 Sep;76(3):183–190. doi: 10.1111/j.1600-0404.1987.tb03565.x. [DOI] [PubMed] [Google Scholar]
  22. Mameli O., Mameli P., Tolu E., Padua G., Melis F., Caria M. A., Virdis A. Analysis of central cardioarrhythmogenic triggers in experimental epilepsy. Epilepsy Res. 1990 Dec;7(3):210–218. doi: 10.1016/0920-1211(90)90017-p. [DOI] [PubMed] [Google Scholar]
  23. Massey E. W., Schoenberg B. S. Mortality from epilepsy. International patterns and changes over time. Neuroepidemiology. 1985;4(2):65–70. doi: 10.1159/000110216. [DOI] [PubMed] [Google Scholar]
  24. Oppenheimer S. M., Cechetto D. F., Hachinski V. C. Cerebrogenic cardiac arrhythmias. Cerebral electrocardiographic influences and their role in sudden death. Arch Neurol. 1990 May;47(5):513–519. doi: 10.1001/archneur.1990.00530050029008. [DOI] [PubMed] [Google Scholar]
  25. Satishchandra P., Chandra V., Schoenberg B. S. Case-control study of associated conditions at the time of death in patients with epilepsy. Neuroepidemiology. 1988;7(3):109–114. doi: 10.1159/000110143. [DOI] [PubMed] [Google Scholar]
  26. Schraeder P. L., Lathers C. M. Paroxysmal autonomic dysfunction, epileptogenic activity and sudden death. Epilepsy Res. 1989 Jan-Feb;3(1):55–62. doi: 10.1016/0920-1211(89)90068-5. [DOI] [PubMed] [Google Scholar]
  27. Schwender L. A., Troncoso J. C. Evaluation of sudden death in epilepsy. Am J Forensic Med Pathol. 1986 Dec;7(4):283–287. doi: 10.1097/00000433-198612000-00003. [DOI] [PubMed] [Google Scholar]
  28. Steiner C., Wit A. L., Weiss M. B., Damato A. N. The antiarrhythmic actions of carbamazepine (Tegretol). J Pharmacol Exp Ther. 1970 Jun;173(2):323–335. [PubMed] [Google Scholar]
  29. Unger A. H., Sklaroff H. J. Fatalities following intravenous use of sodium diphenylhydantoin for cardiac arrhythmias. Report of two cases. JAMA. 1967 Apr 24;200(4):335–336. [PubMed] [Google Scholar]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press

RESOURCES