Sudden death in epileptic patients

Definition: Sudden unexpected death in an epileptic patient which no likely cause - head trauma, drowning, grand mat, bronchial aspiration, suffocatio n - and no anatomic or toxicologic condition which could clearly explain th e death. A seizure reported by witnesses or suspected from clinical signs o bserved prior to death and compatible with the definition raises the proble matic of the relationship with sudden death. Incidence and risk factors: Sudden death is estimated to occur in 1 out of 450 to 2000 epileptic patients, giving an annual incidence of 0.55 to 9.3 p er 1000 patients. Such a wide incidence range can be explained by the diffi culties in providing a rigorous definition of sudden death and more importa ntly by the heterogeneous nature of the population at risk. The risk of sud den death is clearly related to the severity of the epilepsy It is observed in young adults with symptomatic, often difficult to treat epilepsy. Death is frequently observed during sleep. Pathophysiological hypotheses: The circumstances of sudden death in the epi leptic patient illustrate the complex relationships existing between seizur es and irreversible cardiorespiratory dysfunction. Neurogenic lung edema is frequently observed at autopsy and has been confirmed by experimental data . Experimental work and clinical observations would suggest that central ap nea, associated with cardiac dysrhythmia could be involved. Other risk fact ors, including sleep, compliance to treatment, arrhythmogenic effect of cer tain antiepileptics and the consequences of repeated seizures on the myocar dium may also play a role.