Increasing awareness about sudden unexplained death in epilepsy- a review

Abstract

Sudden unexplained death in epilepsy (SUDEP) is the commonest cause of epilepsy-related death and most of the presumed risks factors associated with it are probably avoidable. In Nigeria most deaths in individuals with epilepsy occurred at home and so were never reported. Therefore, autopsies are usually not carried to determine the cause of death. This article hopes to re-awaken the attention of clinicians to this important, yet not so well-known phenomenon, with a view towards addressing problems highlighted Literatures and research publications on SUDEP were systematically reviewed. Case definition, criteria for diagnosis, risk factors, pathophysiology and treatment options for SUDEP and possible methods towards decreasing its incidence was discussed. Incidence of SUDEP increases with the severity of seizure, early onset epilepsy, poor seizure control, generalised tonic-clonic seizure, multiple antiepileptic medications and frequent adjustment of antiepileptic drugs (AEDs). The pathophysiology of SUDEP is not yet clearly elucidated, but it seems to involve interplay of several factors. At the centre of this, is the impaired cardiorespiratory reflexes leading to central apnoea, hypoxia and oedema along with cardiac arrhythmias. Education of patients, relatives and caregivers is crucial to reducing the incidence of SUDEP. Optimal seizure management with an effective monotherapy where possible, should be the goal of the managing physician. In cases of intractable epilepsy, vagal nerve stimulation and neurosurgery should be considered early.