Sudden unexpected death in epilepsy (SUDEP) refers to sudden unexpected dea
th in patients with epilepsy in whom autopsy fails to reveal an anatomic or
toxicological cause of death. The purpose of this study was to examine ass
ociated factors and mechanisms relating to SUDEP in Victoria. The study was
a retrospective study based on data from questionnaires completed by treat
ing doctors and coronial files including police reports of death, autopsy a
nd toxicology reports. The deaths were of people with epilepsy in Victoria
that were referred to the coroner between 1991 and 1997. There were 15 751
coronial autopsies of which 357 had epilepsy and 50 (14%) were SUDEPs. The
SUDEP rate was approximately 1 per 3000 epileptics per year. This study sug
gested the following associations: young age, tonic-clonic seizures, seizur
e frequency greater than 10/year, duration of epilepsy greater than 10 year
s, mental retardation, psychiatric disease and alcohol abuse, Antiepileptic
drug (AED) compliance was rated by treating doctors as good in 24 cases, O
ne or more postmortem AED drug levels was subtherapeutic in 30 of 50 cases.
Only 5 were receiving psychotropic drugs; only 1 of these was receiving mo
re than one of these drugs. A history of recent unusually stressful life ev
ent was present in only 4 cases. At least 11 showed evidence of terminal se
izure, and the majority of events occurred in sleep. These observations sup
port the hypothesis that seizures are the mechanism of many cases of SUDEP.
The associations observed were largely in agreement with previous studies.
However, seizure frequency was greater and duration of epilepsy greater th
an most previous studies. The role of factors such as AED compliance, psych
otropic drug prescription and recent unusually stressful life event is less
clear. This highlights the need for case-control studies of risk factors f
or SUDEP. (C) 2000 Harcourt Publishers Ltd.