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Sudden death in epilepsy

BMJ 2011; 343 doi: (Published 15 November 2011) Cite this as: BMJ 2011;343:d7303
  1. Aidan Neligan, research fellow1,
  2. Gail S Bell, senior research associate1,
  3. Josemir W Sander, professor of neurology2
  1. 1UCL Institute of Neurology, Department of Clinical and Experimental Epilepsy, London WC1N 3BG, UK
  2. 2SEIN—Epilepsy Institute of the Netherlands Foundation, Achterweg 5, Heemstede 2103SW, Netherlands
  1. l.sander{at}

Optimum seizure control and prompt referral to specialist services are essential

People with epilepsy have a higher risk of premature death throughout the course of the condition.1 2 One of the most important causes of mortality is sudden unexpected death in epilepsy (SUDEP), defined as “sudden, unexpected, non-traumatic, and non-drowning death in patients with epilepsy, with or without evidence for a seizure, and excluding documented status epilepticus, in which postmortem examination does not reveal a structural or toxicological cause for death.”3 In practice, all such deaths where an autopsy is performed are classified as definite SUDEP and those in which no autopsy is performed as probable SUDEP.

SUDEP is the most common epilepsy related cause of death in people with chronic epilepsy. Its incidence varies greatly depending on the population studied and the methods used, with a clear increase as the severity of epilepsy increases. Incidence ranges from less than 1 per 1000 person years in people with epilepsy in community based studies, to 2-5 per 1000 person years in people attending tertiary specialist clinics, and 6-9 per 1000 person years in candidates for epilepsy surgery.4 5 Overall, …

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