Sudden Unexplained Death in Epilepsy (SUDEP)


It is the sudden and unexpected death of someone with epilepsy who is otherwise healthy. Epilepsy is a brain disorder that results in repeated seizures. Epilepsy affects both males and females of all races, ethnic backgrounds, and ages. For reasons that are poorly understood, people with epilepsy have an increased risk of dying suddenly for no discernible reason. Some studies suggest that each year approximately one case of SUDEP occurs for every 1,000 people with the epilepsies.

For some, this risk can be higher, depending on several factors. People with more difficult to control seizures tend to have a higher incidence of SUDEP. SUDEP can occur at any age. Researchers are still unsure why SUDEP occurs, although some research points to abnormal heart and respiratory function due to gene abnormalities (ones which cause epilepsy and also affect heart function). People with epilepsy may be able to reduce the risk of SUDEP by carefully taking all anti-seizure medication as prescribed. Not taking the prescribed dosage of medication on a regular basis may increase the risk of SUDEP in individuals with epilepsy, especially those who are taking more than one medication for their epilepsy.

SUDEP Risk Factors

SUDEP accounts for 10% of all epilepsy related deaths. There are factors that increase someone’s chances of SUDEP. These risk factors include:

• Having uncontrolled or poorly controlled epilepsy, also called “refractory epilepsy”.

• Having a long history of generalized tonic clonic seizures.

• Taking 2 or more antiepileptic drugs (AEDs).

• Not taking antiepileptic medications as recommended (low adherence). Autopsies of people who have suffered SUDEP showed that 50% of victims had blood concentrations either below therapeutic levels or in completely undetectable amounts.

• Alcohol abuse.

• Being alone during seizure or having seizures during sleep.

SUDEP Prevention

Controlling seizures is the most important step to avoid SUDEP.

• Keep appointments so your doctor can monitor any changes, and adjust your antiepileptic medications as necessary.

• Take medications for seizures regularly.

• Avoid sudden changes to your medication regimen without first speaking to your physician.

• Maintain a healthy lifestyle with regular and adequate sleep patterns, regular exercise, and regular, nutritious meals.

• Avoid alcohol and recreational drugs.

• Family members, friends and caregivers should be informed to call an ambulance if a seizure lasts for more than five minutes or repeats without full recovery. Also, they should remain with the person for at least 15-¬20 minutes after the seizure to ensure that there is a complete recovery.

Dr. Piyush Ostwal

(Neurology Specialist)

Bahrain Specialist Hospital

Email: [email protected]