REVIEW Sudden unexpected death in epilepsy (SUDEP): risk factors and case control studies

Sudden unexpected death is an important category of mortality in the population with epilepsy. Possible risk factors have been identified from an epidemiological study of this phenomenon, but the exact mechanisms remain unclear. Some of these factors include: male sex; age 20-40 years; generalized seizures; poor seizure control; poor compliance with medication. Case-control studies now being undertaken are the next step in the elucidation of these factors. The results of one study to date reinforce the view that, in the majority of cases, sudden unexpected death in epilepsy (SUDEP) is a seizure-related event. This suggests that improvement in seizure control and the avoidance of polytherapy may be important in risk reduction. An ongoing exploratory case-control study in the UK has identified 154 cases of SUDEP, each of which will have four controls, matched for age and geographical location, in order to examine the influence of various parameters on the risk of sudden death.