Prevention of sudden unexpected death in epilepsy

Abstract

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death related to epilepsy and is associated with treatment resistance and the presence of generalised tonic-clonic seizures (GTCS, of either focal or generalised onset). While the causative mechanisms of SUDEP are yet to be fully elucidated, it is thought that seizure-induced brainstem suppression, and respiratory and cardiac dysfunction may be involved. Research into SUDEP has identified several risk factors (including frequency of GTCS and male gender) but has also indicated proven or potential preventive strategies, including more effective seizure control. Despite increasing awareness and research into SUDEP, its underlying mechanisms and preventive strategies remain poorly defined. More research is needed into the pathophysiology of SUDEP and to identify predictive biomarkers. Furthermore, clinical trials are warranted to assess outcomes with preventive interventions. We review SUDEP epidemiology and risk factors, and discuss potential measures to reduce SUDEP risk.