Sudden death in epilepsy: standards of reporting and the value of toxicological analysis

The authors audited the value of toxicology/histology and reporting standards in sudden death autopsy cases in individuals with epilepsy/seizures. Of 83 cases with epilepsy/seizures and no macroscopically obvious cause of death, 40 had no history of drug/alcohol abuse. Toxicological analysis was performed in 11/40 (28%) and did not contribute to the cause of death in any. Conversely, in individuals with epilepsy with known drug/alcohol abuse and cases with a history of seizures related to drug/alcohol abuse, toxicological analysis was performed in 17/22 (77%) and 14/21 (67%), contributing to the causes of death in 8/17 (47%) and 10/14 (71%), respectively. Details of seizures were poorly reported, possibly due to a lack of information from the coroner's office, while autopsy findings were recorded diligently. The authors provide an evidence base for the RCPath guidelines and suggest that taking toxicology samples is essential only when there is a history of drug/alcohol abuse or suspicion of overdose.