Sudden unexpected death in epilepsy

Lancet. 2011 Dec 10;378(9808):2028-2038. doi: 10.1016/S0140-6736(11)60176-1. Epub 2011 Jul 5.


Sudden unexpected death in epilepsy (SUDEP) refers to the sudden death of a seemingly healthy individual with epilepsy, usually occurring during, or immediately after, a tonic-clonic seizure. The frequency of SUDEP varies depending on the severity of the epilepsy, but overall the risk of sudden death is more than 20 times higher than that in the general population. Several different mechanisms probably exist, and most research has focused on seizure-related respiratory depression, cardiac arrhythmia, cerebral depression, and autonomic dysfunction. Data from a pooled analysis of risk factors indicate that the higher the frequency of tonic-clonic seizures, the higher the risk of SUDEP; furthermore, risk of SUDEP is also elevated in male patients, patients with long-duration epilepsy, and those on antiepileptic polytherapy. SUDEP usually occurs when the seizures are not witnessed and often at night. In this Seminar, we provide advice to clinicians on ways to minimise the risk of SUDEP, information to pass on to patients, and medicolegal aspects of these deaths.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Age Distribution
  • Anticonvulsants / administration & dosage
  • Anticonvulsants / adverse effects
  • Apnea / physiopathology
  • Arrhythmias, Cardiac / physiopathology
  • Cardiac Pacing, Artificial
  • Causality
  • Death, Sudden / etiology*
  • Death, Sudden / prevention & control
  • Drug Therapy, Combination
  • Electroencephalography
  • Epilepsy / complications*
  • Epilepsy / drug therapy
  • Epilepsy / physiopathology
  • Heart Arrest / physiopathology
  • Heart Rate / physiology
  • Humans
  • Hypoventilation / physiopathology
  • Long QT Syndrome / complications
  • Malpractice
  • Neurosurgical Procedures
  • Patient Education as Topic
  • Risk Factors
  • Seizures / complications
  • Seizures / physiopathology
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Sex Distribution
  • Sleep / physiology
  • Telemetry
  • Vagus Nerve Stimulation


  • Anticonvulsants
  • Serotonin Uptake Inhibitors