SUDEP and its risk factors

One of the most concerning causes of epilepsy mortality is sudden unexpected death in epilepsy (SUDEP). Deaths categorized as SUDEP encompass non traumatic non drowning-related deaths in people with epilepsy that may or may not be associated with a recent seizure but are not due to status epilepticus. In definite SUDEP, most autopsies reveal no signs of any anatomic or toxic cause of death. SUDEP is the most common of the epilepsy-related causes of death, and the risk of sudden death in people with epilepsy is more than 20 times greater than that of the general population, making efforts to prevent this condition of supreme interest and importance.Current studies suggest SUDEP incidence rates range from 0.1 per 1000 person-years to 2.3 per 1000 person-years in community samples; from 1.1 per 1000 person-years to 5.9 per 1000 person-years for people treated in epilepsy centers, many of whom have refractory epilepsy; and from 6.3 per 1000 person-years to 9.3 per1000person-years among those who are candidates for epilepsy surgery or who have seizures after surgery. Risk factors for SUDEP have been identified in a number of studies. The strongest SUDEP risk factor was found to be recurrent seizures. Other seizure related risk factors include onset of epilepsy at an early age, ongoing frequent seizures, frequent generalized tonic clonic seizures, and a long duration of epilepsy. An IQ below 70 in the presence of a major neurologic insult and neurologic pathologic abnormality such as stroke are also identified as potential risk factors. The only way to treat SUDEP is to prevent it,and the only way to do this is to prevent seizures from occurring in the first place. Other risk-mitigation strategies include supervision at night, sleeping in the same room as an adult, and installing monitoring devices; these may offer opportunities to help someone who is having seizures during sleep. Besides SUDEP, accidental death is also a large contributor to epilepsy mortality. The risk of death from drowning is higher in patients with epilepsy, with a relative risk ranging from 13 to 19 times greater than the general population. The best approach in managing the risks of accidental death is appropriate safety counseling for the patient and family.