[Sudden death in epilepsy: clinical experience]

The disconcerting experience of sudden unexpected death in epilepsy (SUDEP) obliges the clinician to consider the differential diagnosis and study the mechanisms by which it may be prevented.

A 13 year old patient with idiopathic generalized epilepsy and a history of febrile convulsions, both also described in the family history, who suddenly died at his home from no apparent cause. The legal autopsy findings were normal. The serum levels of valproic acid, previously normal, were non existent at death. In this case the differential diagnosis included intentional causes, ingestion of toxic substances, feeding disorders, long QT syndrome and SUDEP.

After considering the available evidence we suggest that this was a case of SUDEP. Epidemiological studies specifically designed to seek risk factors may suggest preventive measures even when the causes and pathogenic mechanisms of the disorder are not known. The creation of a national SUDEP register would be a great step in this direction.