[Sudden unexpected and unexplained death in epilepsy]

Sudden unexpected death in epilepsy (SUDEP) is a rare and disconcerting event, scarcely reported in our country.

The definition proposed at the last meeting of experts, in 1997, excludes all cases with a known cause of death, except for the seizure itself or the antecedent of epilepsy. The cause-effect relationship between epileptic seizure and sudden death has not been definitely proved but relies heavily on the following facts: 1. Epidemiologic studies: the incidence of SUDEP is larger in severe epilepsy, as shown by hospital records, than in epileptics of the general population; increases proportionately with the increasing requirements of antiepileptic polytherapy, and with raised seizure frequency (except for Idiopathic Epilepsy, where this fact has not been documented). 2. Physiologic studies in humans during seizures, suggest that in some cases a central apnea occurs, occasionally followed by asystole; in some others, cardiac arrhythmia, of reflex neural origin, have been detected. Animal experiments support the first hypothesis. 3. The latest pathologic studies at autopsy support also the second hypothesis: cardiac ischemia due to repeated vasospasms, neurally activated, during seizures. A causal relationship of SUDEP with antiepileptic drugs administration has not been proved, but the sudden decrease of antiepileptic drugs serum levels may cause cardiac arrhythmias potentially fatal. Differential diagnosis with certain cardiopathies should be performed.

For the time present, only a better knowledge of the risk factors of SUDEP will allow us to reduce its incidence.