Sudden death in epilepsy

Every year, 5,000 people with epilepsy die of sudden unexpected death (SUDEP) in the United States alone, a reflection of a 20-fold increased risk of this devastating complication compared to the general population.1 Patients with uncontrolled seizures are particularly vulnerable. So, our knee-jerk reaction as neurologists trying to understand SUDEP has been to investigate various theories of how seizures can cause sudden death: after all, patients with epilepsy are dying, so of course the brain must be at the heart of the problem. Tremendous past and ongoing efforts have investigated various potential seizure-related consequences that may compromise cardiac and respiratory function, including sympathetic hyperactivation, parasympathetic suppression2 or overdrive,3 abnormal heart rate variability, and respiratory suppression.4 A new study published in this issue of Neurology ®,5 led by neurologists and cardiologists, took a population-based approach and asked the question slightly differently, providing a broader perspective.