Sudden unexpected death in people with epilepsy: a pediatric perspective

The possibility of sudden unexpected death in people with epilepsy (SUDEP) is very frightening for parents of a child with epilepsy. The mechanism for SUDEP is unclear but is probably most commonly related to postictal respiratory insufficiency. Occasionally the cause is a cardiac arrhythmia induced by a seizure. Even though children with epilepsy have an increased risk of death, SUDEP is very rare (1-2/10,000 patient-years). Nearly all of the mortality in children with epilepsy is related to the underlying neurologic disorder, not the seizures. Normal children with epilepsy do not have an increased risk of death compared with the general population. There is no current proven strategy to prevent SUDEP, although its rarity precludes systematic trials. Common sense approaches include identifying patients with cardiac arrhythmias as the cause of misdiagnosed epilepsy and vigorous attempts to control resistant seizure disorders.