Sudden unexpected death in epilepsy

basic mechanisms and clinical implications for prevention

Dlouhy, Brian J
Gehlbach, Brian K
Richerson, George B

¹Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
²Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
³Department of Neurology, University of Iowa, Iowa City, Iowa, USA
⁴Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA
⁵Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, Iowa, USA

Dr Brian J Dlouhy, Department of Neurosurgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242, USA; [email protected]

Received June 9, 2014

Received in revised form May 5, 2015

Accepted May 13, 2015

Journal of Neurology, Neurosurgery, & Psychiatry 87(4):p 402-413, April 2016. | DOI: 10.1136/jnnp-2013-307442

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in patients with intractable epilepsy. The substantial lifetime risk of SUDEP and the lack of a clear pathophysiological connection between epilepsy itself and sudden death have fuelled increased attention to this phenomenon. Understanding the mechanisms underlying SUDEP is paramount to developing preventative strategies. In this review, we discuss SUDEP population studies, case–control studies, witnessed and monitored cases, as well as human seizure cardiorespiratory findings related to SUDEP, and SUDEP animal models. We integrate these data to suggest the most probable mechanisms underlying SUDEP. Understanding the modifiable risk factors and pathophysiology allows us to discuss potential preventative strategies.