COMPARISON OF ANTIEPILEPTIC DRUG LEVELS IN DIFFERENT CASES OF SUDDEN-DEATH

Sudden unexplained death syndrome (SUDS) in epilepsy is identified as death in an epileptic individual with no anatomic cause found at autop sy. SUDS appears to be associated with subtherapeutic levels of antico nvulsants. Sudden death with no demonstrable cause at autopsy accounts for 5% to 30% of deaths in epileptic individuals. In the majority of cases, however, the cause of death in epileptic individuals can be dem onstrated at autopsy. We examined the anti-epileptic drug concentratio ns in decedents who died as a direct result of epilepsy and compared t hese findings with those from a control population of epileptic patien ts who died suddenly due to some unrelated cause. This retrospective s tudy was conducted on all deaths involving patients with epilepsy exam ined at the Jefferson County Coroner/Medical Examiner office from 1986 -95. Out of 115 total cases the underlying cause of death was epilepsy in 60 cases-52 cases of SUDS and 8 deaths caused by an accident preci pitated by a seizure. In 44 cases death was unrelated to the decedent' s epilepsy. In 11 cases the contribution of epilepsy to death could no t be determined. Published articles on SUDS report subtherapeutic anti -epileptic medication levels in 63% to 94% of cases. We found subthera peutic drug levels in 69% of the 52 cases of SUDS, in 75% of the 8 cas es where a seizure precipitated an accident causing death, and in 34% of the control population. The incidence of subtherapeutic anticonvuls ants is significantly greater in patients dying as a direct result of their epilepsy than in those dying of an unrelated cause.