Sudden unexpected death in epilepsy

Introduction

Patients with epilepsy have a mortality rate significantly higher than that of the general population. Sudden unexpected death in epilepsy is a major diagnostic category in epilepsy, accounting for between 500 and 1000 deaths per year.

 

Case reports

Case 1: A 65-year-old male with a past history of epilepsy had a witnessed seizure. Approximately two hours later he was found unresponsive. No significant natural diseases were found at the autopsy. Neuropathological examination showed non-specific changes within the hippocampus. Toxicological analysis detected carbamazepine and valproic acid. Vitreous humour biochemistry was unremarkable. Case 2: A 56-year-old male with a past history of epilepsy was found by his mother unresponsive. Resuscitation was attempted but failed. No significant natural diseases were found at the autopsy. The neuropathological examination did not reveal an epileptic focus. Toxicological analysis revealed carbamazepine and phenytoin. Vitreous humour biochemistry was unremarkable. Case 3: A 45-year-old female with a past history of epilepsy was found on the floor unresponsive. She was off antiepileptic treatment for the last two weeks. No significant natural diseases were found at the autopsy. The neuropathological examination did not reveal an epileptic focus. The regular antiepileptic medications were not detected in the toxicological analysis. Vitreous humour biochemistry was unremarkable.

 

Conclusions

The above-mentioned cases were classical SUDEP deaths. The diagnosis of SUDEP mainly depends on exclusion. The need of thorough histopathology examination including neuropathology, a complete toxicological analysis including vitreous humour biochemistry is highlighted here in the event of epileptic deaths.