Sudden Death in Epilepsy (SUDEP)

Sudden death in epilepsy (SUDEP) is a somewhat controversial syndrome that occurs when an individual with epilepsy dies in their sleep without an obvious cause. SUDEP is thought to be related to respiratory insufficiency after a seizure or a cardiac arrthymia that occurs with a seizure. Numerous descriptive case studies are available, and shed some light on the epidemiology, but SUDEP is not well understood. The incidence of SUDEP is very rare in children (1-2/10,000 patient-years) [Camfield: 2005], but occurs in increasing frequency in adolesence and adulthood, accounting for 2-17% of deaths in individuals at a seizure-referral center. [Ficker: 2000]

Causes of SUDEP in children might be different than those in adults. Childhood deaths in children with epilepsy may be more often due to their underlying disorder. SUDEP may occur more frequently in children with developmental delay/intellectual disability, children with difficult to control seizures,and children with seizures that began early in the child's life. [Weber: 2005] [Camfield: 2005] In addition, children with SUDEP were more likely to be sleeping in a prone position and to have generalized tonic-clonic epilepsy. [McGregor: 2006] Polypharmacy and low serum antiepileptic medication levels are found in autopsies of adults with SUDEP, but not necessarily in autopsies of children. Some investigators believe that good seizure control may help prevent SUDEP. [Tomson: 2005]

Some investigators have found that children with epilepsy who are typically developing have no increase in risk of death compared to the general population, [Camfield: 2005] however other studies suggest that SUDEP is found in children with idiopathic and symptomatic epilepsy. [Donner: 2001]


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Kanner AM.
Unraveling the secrets of sudden death in epilepsy: is it possible?.
Epilepsy Curr. 2004;4(6):225-6. PubMed abstract / Full Text


Author: Lynne M. Kerr, MD, PhD - 6/2011
Content Last Updated: 6/2011

Page Bibliography

Camfield P, Camfield C.
Sudden unexpected death in people with epilepsy: a pediatric perspective.
Semin Pediatr Neurol. 2005;12(1):10-4. PubMed abstract

Donner EJ, Smith CR, Snead OC 3rd.
Sudden unexplained death in children with epilepsy.
Neurology. 2001;57(3):430-4. PubMed abstract

Ficker DM.
Sudden unexplained death and injury in epilepsy.
Epilepsia. 2000;41 Suppl 2:S7-12. PubMed abstract

McGregor A, Wheless J.
Pediatric experience with sudden unexplained death in epilepsy at a tertiary epilepsy center.
J Child Neurol. 2006;21(9):782-7. PubMed abstract

Tomson T, Walczak T, Sillanpaa M, Sander JW.
Sudden unexpected death in epilepsy: a review of incidence and risk factors.
Epilepsia. 2005;46 Suppl 11:54-61. PubMed abstract

Weber P, Bubl R, Blauenstein U, Tillmann BU, Lutschg J.
Sudden unexplained death in children with epilepsy: a cohort study with an eighteen-year follow-up.
Acta Paediatr. 2005;94(5):564-7. PubMed abstract