Sudden Death in Epilepsy: Forensic and Clinical Issues

Though it is one of the most common causes of death in epilepsy patients, SUDEP is still infrequently and even reluctantly named on autopsy reports. This under-reporting equates to a lack of attention and earnest investigation into the cause, predisposition, and prevention of SUDEP. There is as yet little effort to establish an actionable strategy in the mitigation of these potentially fatal arrhythmias.

Expanding on the 1990 book Epilepsy and Sudden Death, edited by Lathers and Schraeder, Sudden Death in Epilepsy: Forensic and Clinical Issues reviews of the basic science of epilepsy as it relates to SUDEP. Clinical chapters study the sophisticated simultaneous ambulatory EKG and EEG telemetry and respiratory function monitoring of patients at risk for sudden death that will help identify cardiac, respiratory, and epileptogenic interactions involved. Chapters on animal models evaluate new data from studies that build on previously used models and emphasize that multiple models are needed to investigate the pathophysiology of SUDEP, to hypothesize about effective treatments, to develop pilot studies in persons with epilepsy, and to conduct confirmatory large-scale clinical trials.

Contributions discuss the interaction between the central and peripheral autonomic nervous systems and the cardiopulmonary systems; proposed mechanistic factors in SUDEP; risk categories of arrhythmogenic, respiratory, and hypoxia related cardiac death; psychological, emotional, and stress related factors; the role of alcohol and drugs in seizures; and the potential mitigating properties of antiepileptic medication.

Adopting a global, multidisciplinary focus to address the mystery of SUDEP, this important work provides clinicians, researchers, patients, and families with the knowledge to freely discuss the phenomenon and thereby discover the preventive treatment regimens to decrease the occurrence of SUDEP.