Abstract
The majority of persons with epilepsy develop lasting remission from seizures, although mortality is significantly greater than that of the age-matched general population. Of the deaths that are thought to be directly related to seizures, sudden unexpected death in epilepsy is probably the commonest category; more so than status epilepticus or seizure-related accidents. Annual incidence rates vary from 1 in 200 patients with chronic epilepsy to about 1 in 1000 in more population-based studies. Young adults with severe, intractable epilepsy appear to be the most frequently affected group and may have even higher incidence rates. Other risk factors may also be important. An area of great research interest, several pathogenetic mechanisms have been postulated, centering mainly around cardiac rhythm and central hypoventilation. Given the frequent devastation caused by sudden unexpected death in epilepsy, the importance of seizure control is emphasised. Keywords: epilepsy; sudden death
Full Text
The Full Text of this article is available as a PDF (72.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aldenkamp A. P. Effect of seizures and epileptiform discharges on cognitive function. Epilepsia. 1997;38 (Suppl 1):S52–S55. doi: 10.1111/j.1528-1157.1997.tb04520.x. [DOI] [PubMed] [Google Scholar]
- Annegers J. F., Coan S. P., Hauser W. A., Leestma J., Duffell W., Tarver B. Epilepsy, vagal nerve stimulation by the NCP system, mortality, and sudden, unexpected, unexplained death. Epilepsia. 1998 Feb;39(2):206–212. doi: 10.1111/j.1528-1157.1998.tb01360.x. [DOI] [PubMed] [Google Scholar]
- 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]
- Cockerell O. C., Johnson A. L., Sander J. W., Hart Y. M., Goodridge D. M., Shorvon S. D. Mortality from epilepsy: results from a prospective population-based study. Lancet. 1994 Oct 1;344(8927):918–921. doi: 10.1016/s0140-6736(94)92270-5. [DOI] [PubMed] [Google Scholar]
- Cockerell O. C., Johnson A. L., Sander J. W., Shorvon S. D. Prognosis of epilepsy: a review and further analysis of the first nine years of the British National General Practice Study of Epilepsy, a prospective population-based study. Epilepsia. 1997 Jan;38(1):31–46. doi: 10.1111/j.1528-1157.1997.tb01075.x. [DOI] [PubMed] [Google Scholar]
- 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]
- Dasheiff R. M. Sudden unexpected death in epilepsy: a series from an epilepsy surgery program and speculation on the relationship to sudden cardiac death. J Clin Neurophysiol. 1991 Apr;8(2):216–222. [PubMed] [Google Scholar]
- Derby L. E., Tennis P., Jick H. Sudden unexplained death among subjects with refractory epilepsy. Epilepsia. 1996 Oct;37(10):931–935. doi: 10.1111/j.1528-1157.1996.tb00529.x. [DOI] [PubMed] [Google Scholar]
- Earnest M. P., Thomas G. E., Eden R. A., Hossack K. F. The sudden unexplained death syndrome in epilepsy: demographic, clinical, and postmortem features. Epilepsia. 1992 Mar-Apr;33(2):310–316. doi: 10.1111/j.1528-1157.1992.tb02321.x. [DOI] [PubMed] [Google Scholar]
- Fincham R. W., Shivapour E. T., Leis A. A., Martins J. B. Ictal bradycardia with syncope: a case report. Neurology. 1992 Nov;42(11):2222–2223. doi: 10.1212/wnl.42.11.2222. [DOI] [PubMed] [Google Scholar]
- George J. R., Davis G. G. Comparison of anti-epileptic drug levels in different cases of sudden death. J Forensic Sci. 1998 May;43(3):598–603. [PubMed] [Google Scholar]
- 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]
- 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]
- Howell S. J., Blumhardt L. D. Cardiac asystole associated with epileptic seizures: a case report with simultaneous EEG and ECG. J Neurol Neurosurg Psychiatry. 1989 Jun;52(6):795–798. doi: 10.1136/jnnp.52.6.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnston S. C., Darragh T. M., Simon R. P. Postictal pulmonary edema requires pulmonary vascular pressure increases. Epilepsia. 1996 May;37(5):428–432. doi: 10.1111/j.1528-1157.1996.tb00587.x. [DOI] [PubMed] [Google Scholar]
- Johnston S. C., Horn J. K., Valente J., Simon R. P. The role of hypoventilation in a sheep model of epileptic sudden death. Ann Neurol. 1995 Apr;37(4):531–537. doi: 10.1002/ana.410370416. [DOI] [PubMed] [Google Scholar]
- Klenerman P., Sander J. W., Shorvon S. D. Mortality in patients with epilepsy: a study of patients in long term residential care. J Neurol Neurosurg Psychiatry. 1993 Feb;56(2):149–152. doi: 10.1136/jnnp.56.2.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Langan Y., Nolan N., Hutchinson M. The incidence of sudden unexpected death in epilepsy (SUDEP) in South Dublin and Wicklow. Seizure. 1998 Oct;7(5):355–358. doi: 10.1016/s1059-1311(05)80002-0. [DOI] [PubMed] [Google Scholar]
- Leestma J. E., Annegers J. F., Brodie M. J., Brown S., Schraeder P., Siscovick D., Wannamaker B. B., Tennis P. S., Cierpial M. A., Earl N. L. Sudden unexplained death in epilepsy: observations from a large clinical development program. Epilepsia. 1997 Jan;38(1):47–55. doi: 10.1111/j.1528-1157.1997.tb01076.x. [DOI] [PubMed] [Google Scholar]
- Leestma J. E., Kalelkar M. B., Teas S. S., Jay G. W., Hughes J. R. Sudden unexpected death associated with seizures: analysis of 66 cases. Epilepsia. 1984 Feb;25(1):84–88. doi: 10.1111/j.1528-1157.1984.tb04159.x. [DOI] [PubMed] [Google Scholar]
- 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]
- Leppik I. E. Tiagabine: the safety landscape. Epilepsia. 1995;36 (Suppl 6):S10–S13. doi: 10.1111/j.1528-1157.1995.tb06009.x. [DOI] [PubMed] [Google Scholar]
- Lhatoo S. D., Langan Y., MacDonald B. K., Zeidan S., Sander J. W. Sudden unexpected death: a rare event in a large community based prospective cohort with newly diagnosed epilepsy and high remission rates. J Neurol Neurosurg Psychiatry. 1999 May;66(5):692–693. doi: 10.1136/jnnp.66.5.692. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lip G. Y., Brodie M. J. Sudden death in epilepsy: an avoidable outcome? J R Soc Med. 1992 Oct;85(10):609–611. [PMC free article] [PubMed] [Google Scholar]
- Nashef L., Fish D. R., Garner S., Sander J. W., Shorvon S. D. Sudden death in epilepsy: a study of incidence in a young cohort with epilepsy and learning difficulty. Epilepsia. 1995 Dec;36(12):1187–1194. doi: 10.1111/j.1528-1157.1995.tb01061.x. [DOI] [PubMed] [Google Scholar]
- Nashef L., Fish D. R., Sander J. W., Shorvon S. D. Incidence of sudden unexpected death in an adult outpatient cohort with epilepsy at a tertiary referral centre. J Neurol Neurosurg Psychiatry. 1995 Apr;58(4):462–464. doi: 10.1136/jnnp.58.4.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nashef L., Garner S., Sander J. W., Fish D. R., Shorvon S. D. Circumstances of death in sudden death in epilepsy: interviews of bereaved relatives. J Neurol Neurosurg Psychiatry. 1998 Mar;64(3):349–352. doi: 10.1136/jnnp.64.3.349. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nashef L., Sander J. W. Sudden unexpected deaths in epilepsy--where are we now? Seizure. 1996 Sep;5(3):235–238. doi: 10.1016/s1059-1311(96)80042-2. [DOI] [PubMed] [Google Scholar]
- Nashef L., Walker F., Allen P., Sander J. W., Shorvon S. D., Fish D. R. Apnoea and bradycardia during epileptic seizures: relation to sudden death in epilepsy. J Neurol Neurosurg Psychiatry. 1996 Mar;60(3):297–300. doi: 10.1136/jnnp.60.3.297. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Natelson B. H., Suarez R. V., Terrence C. F., Turizo R. Patients with epilepsy who die suddenly have cardiac disease. Arch Neurol. 1998 Jun;55(6):857–860. doi: 10.1001/archneur.55.6.857. [DOI] [PubMed] [Google Scholar]
- Nilsson L., Farahmand B. Y., Persson P. G., Thiblin I., Tomson T. Risk factors for sudden unexpected death in epilepsy: a case-control study. Lancet. 1999 Mar 13;353(9156):888–893. doi: 10.1016/s0140-6736(98)05114-9. [DOI] [PubMed] [Google Scholar]
- O'Donoghue M. F., Sander J. W. A historical perspective on the mortality associated with chronic epilepsy. Acta Neurol Scand. 1997 Sep;96(3):138–141. doi: 10.1111/j.1600-0404.1997.tb00255.x. [DOI] [PubMed] [Google Scholar]
- Ramabadran K., Bansinath M. Endogenous opioid peptides and epilepsy. Int J Clin Pharmacol Ther Toxicol. 1990 Feb;28(2):47–62. [PubMed] [Google Scholar]
- Sander J. W., Hart Y. M., Johnson A. L., Shorvon S. D. National General Practice Study of Epilepsy: newly diagnosed epileptic seizures in a general population. Lancet. 1990 Nov 24;336(8726):1267–1271. doi: 10.1016/0140-6736(90)92959-l. [DOI] [PubMed] [Google Scholar]
- Sperling M. R., O'Connor M. J., Saykin A. J., Plummer C. Temporal lobectomy for refractory epilepsy. JAMA. 1996 Aug 14;276(6):470–475. [PubMed] [Google Scholar]
- Tavernor S. J., Brown S. W., Tavernor R. M., Gifford C. Electrocardiograph QT lengthening associated with epileptiform EEG discharges--a role in sudden unexplained death in epilepsy? Seizure. 1996 Mar;5(1):79–83. doi: 10.1016/s1059-1311(96)80067-7. [DOI] [PubMed] [Google Scholar]
- Tennis P., Cole T. B., Annegers J. F., Leestma J. E., McNutt M., Rajput A. Cohort study of incidence of sudden unexplained death in persons with seizure disorder treated with antiepileptic drugs in Saskatchewan, Canada. Epilepsia. 1995 Jan;36(1):29–36. doi: 10.1111/j.1528-1157.1995.tb01661.x. [DOI] [PubMed] [Google Scholar]
- Terrence C. F., Jr, Wisotzkey H. M., Perper J. A. Unexpected, unexplained death in epileptic patients. Neurology. 1975 Jun;25(6):594–598. doi: 10.1212/wnl.25.6.594. [DOI] [PubMed] [Google Scholar]
- Tigaran S., Rasmussen V., Dam M., Pedersen S., Høgenhaven H., Friberg B. ECG changes in epilepsy patients. Acta Neurol Scand. 1997 Aug;96(2):72–75. doi: 10.1111/j.1600-0404.1997.tb00242.x. [DOI] [PubMed] [Google Scholar]
- Timmings P. L. Sudden unexpected death in epilepsy: a local audit. Seizure. 1993 Dec;2(4):287–290. doi: 10.1016/s1059-1311(05)80142-6. [DOI] [PubMed] [Google Scholar]
- Zieliński J. J. Epilepsy and mortality rate and cause of death. Epilepsia. 1974 Jun;15(2):191–201. doi: 10.1111/j.1528-1157.1974.tb04941.x. [DOI] [PubMed] [Google Scholar]