Sudden unexplained death in children with epilepsy

Background: Sudden unexplained death is a significant cause of mortality in people with epilepsy. Risk factors that have been identified include male sex, poor compliance with medications, and antiepileptic drug (AED) polypha rmacy. However, these may not apply to the pediatric population in which th e causes of epilepsy differ from the adult population. Therefore, risk fact ors for sudden unexplained death in epilepsy (SUDEP) in children must be ev aluated independently from those in the adult population. Methods: Cases of SUDEP in children less than 18 years of age occurring over a 10-year perio d in the province of Ontario, Canada, were identified. Records were reviewe d for demographic and clinical features and neuropathology findings. Result s: Twenty-seven cases of SUDEP in children were identified. Sixty-three per cent were male. Age at death ranged from 8 months to 15 years. Fourteen chi ldren had symptomatic epilepsy (52%), five had cryptogenic epilepsy (18%), and eight had idiopathic epilepsy (Wi). Twelve children were treated with o ne AED (46%), 10 were on two AED (38%), and three were on three AED (12%). At the time of death, seven children had one serum AED concentration below the therapeutic range (35%) and 12 children had AED levels within the thera peutic range (60%). Conclusions: This case series represents the largest se ries of sudden unexplained death in children with epilepsy. At least two pr eviously described risk factors for SUDEP in adults, low serum AED levels a t time of death and AED polytherapy, do not appear to be significant in chi ldren.