SUDEP The death of nihilism

In 1904, Spratling noted that single, brief seizures kill 3%-4% of people with epilepsy.(1) More recently, knowledge about sudden unexpected death in epilepsy (SUDEP) has grown dramatically. Our conceptualization of SUDEP has crystalized. We have evidence that SUDEPs largely follow seizures(2) and our collective knowledge suggests that preventing seizures, where possible, especially generalized convulsive seizures (GCS), should prevent most SUDEPs. Meta-analyses of randomized controlled trials of antiepileptic drugs (AEDs) reveal lower SUDEP rates with adjunctive AEDs.(3) Only 7%-38% of SUDEPs are witnessed,(2) suggesting that witnessed seizures are safer. Patients supervised during sleep have lower SUDEP rates.(2,4)