The medical records of residents of a facility for persons with mental reta
rdation from January 1, 1978, through December 31, 1997, were analyzed to i
dentify incidence of sudden unexpected death for groups of 180 individuals
with and 125 without comorbid epilepsy. Eighty deaths were identified, with
55 occurring in the epilepsy group and 25 in the nonepilepsy group. The ra
te of sudden unexpected death was 1.3 deaths per 1,000 patient years in the
nonepilepsy group and 3.6 deaths per 1,000 patient years in the epilepsy g
roup. The risk factors for sudden unexpected death in the epilepsy group we
re nonambulatory status and poorly controlled seizure disorder (increased s
eizure rate and increased number of antiepileptic drugs).