Sudden unexpected death in epilepsy in Victoria

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.