Sudden unexpected death in epilepsy: impact on clinical practice

The possibility of sudden unexpected death in epilepsy (SUDEP) should affect the management of virtually every patient with proven or suspected epilepsy by (a) underlining the need to make all reasonable efforts to render each patient seizure-free; (b) emphasizing the importance of minimizing avoidable seizures; (c) being incorporated into the risk/benefit analysis of decisions to withdraw or switch antiepileptic drugs (AEDs); (d) justifying the risks of experimental drugs or surgery in some patients with severe and/or medically intractable seizures; (e) requiring a minimum delay in the investigation and treatment in all patients with possible or confirmed epilepsy; (f) prohibiting abrupt outpatient AED withdrawal in patients suspected but not proved to have solely nonepileptic attacks, lest they have additional seizures; (g) emphasizing the need for a good patient/physician relationship; (h) ensuring suitable monitoring and resuscitation facilities for high-risk inpatient groups; and (i) taking into account the home environment and attendant risks for seizures in isolated circumstances when outpatient treatment strategies are planned. It is vital to establish what proportion of SUDEP cases occur in relation to avoidable factors and to determine whether improvements in overall quality of care of patients with epilepsy might modify the incidence of SUDEP.