Sudden unexpected death (SUD) occurred in an epileptic patient after a seizure. The patient had a witnessed seizure with electrocardiographic evidence of a cardiac arrhythmia. Immediate cardiopulmonary resuscitation in the hospital was ineffective. Autopsy revealed no anatomic cause of death. This case supports a cardiac cause for SUD in this patient. The mechanism of death remains speculative despite its setting in an epilepsy center. The seven-year experience with SUD at the epilepsy center is reviewed.