Sudden unexpected death in epilepsy in children and adolescents

Introduction. Sudden unexpected death in epilepsy (SUDEP) is an important cause of death in young epileptic patients. However, it is relatively unknown to neurologists. Objective. To analyze the frequency and clinicopathological characteristics of SUDEP as a cause of sudden death (SD) in young persons. Patients and methods. An observational study of all SD due to SUDEP in persons aged 1-35 years occurring between 1991 and 1998 in Bizkaia, in whom medico-legal autopsy was done. In all cases a full autopsy was done and the previous clinical history was investigated. Results. Eight of the 107 cases of SD (75%) were due to SUDEP. Five were aged between 25 and 29 years and in this age group it was the commonest cause of death (22%). Six had been diagnosed as having idiopathic epilepsy and two as having posttraumatic epilepsy. Generalized convulsions occurred in 75%. Four patients died when they were alone. Two patients had epileptic seizures hours before their death. At necropsy no structural changes were seen in the brain except in the two patients with posttraumatic epilepsy. Pulmonary oedema was a frequent finding. In 50% of the dead patients, chemico-toxicological study showed there to be no trace of the drugs they had been prescribed. Conclusions, Although SD is rare, SUDEP is an important cause of mortality in young epileptics. Violent death in relation to epilepsy causes problems in forensic medicine. Although the mechanisms of SUDEP are not clear, it would seem necessary to increase medical control of this disorder, especially in young people.