Sudden Unexpected Death In Epilepsy

Sudden unexpected (or unexplained) death in epilepsy (SUDEP) is a major concern for people with epielpsy and healthcare providers, but is seldom discussed in typical office visits. For reasons that are not completely understood, people with epilepsy have approximately double the risk of premature death compared to the general population, and the risk of sudden unexpected death is approximately 20-fold higher. These sudden unexpected deaths appear to be seizure-related in most cases, with accompanied cardiac failure (e.g. arrhythmia) or respiratory failure (e.g. apnea), or both. The risk is highest for young adults with uncontrolled and frequent generalized convulsive seizures. Although the increase in risk is concerning, these events are still uncommon overall. Estimates of the overall frequency of SUDEP among people with epilepsy vary markedly from study to study, but tend to hover around 1 in 1000. There are unfortunately no definite proven strategies for reducing this risk, aside from reducing seizure frequency—which is of course the goal of epilepsy therapy in general. There is some limited data now suggesting that supplemental fish oil may be of benefit in further reducing the risk, but this needs to be confirmed before it is universally recommended. There are no specific estimates of the risk of SUDEP among children with infantile spasms, though the risk appears to be quite low.


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