[Epilepsy and death]

Abstract

Background: The risk of premature death in the epilepsy population is estimated to be two or three times of that in the general population. Premature death is partly a consequence of the aetiology of the epilepsy (tumours, infections, cerebrovascular insults etc.), partly a direct or indirect consequence of a seizure: head trauma, drowning, traffic accident, suicide, status epilepticus, and sudden unexpected death in epilepsy (SUDEP).

Material and methods: On the basis of a review of the current literature on sudden unexpected death in epilepsy, we discuss incidence, risk factors and the assumed pathophysiological mechanisms.

Results: Most of these deaths are probably seizure-related. Among patients between 20 and 45, sudden unexpected death is the most frequently occurring epilepsy-related cause of death. In patients with refractory epilepsy, sudden unexpected death comprises about 10% of deaths; the incidence is about 1:200-300 per year. Risk factors are symptomatic epilepsy, tonic-clonic seizures, early onset of the epilepsy, polytherapy, and non-compliance. Ictal central apnoe or ictal fatal cardioarrhythmia are probably the most plausible explanations for these deaths.

Interpretation: Some of these deaths may be prevented by better seizure control. Patients and their families should be given balanced information about this potential outcome. Family members should learn first aid and resuscitation.