Sudden Death in Epilepsy: An Avoidable Outcome?

In a retrospective survey of mortality among the first 1000 unselected patients referred to the Epilepsy Research Unit at the Western Infirmary in Glasgow between 1985 and 1990, a total of 18 deaths were identified. Three patients had committed suicide and one each had died of status epilepticus in hospital, a subdural haematoma and a myocardial infarction. The remaining 12 deaths (67%) were sudden (median age 32 years; range 22-68 years). Poor seizure control and poor compliance with antiepileptic drug therapy were recorded in only three (25%) of these patients. There was a change in antiepileptic drug regimen in five (28%) in the month before death. Only two (17%) underwent postmortem examination. In nine of the 12 patients dying suddenly, the primary cause of death was not listed as epilepsy but as asphyxia (3), aspiration (2) and one each of ischaemic heart disease, myocardial infarction, asystole and drowning (in the bath). 'Status epilepticus' was assumed to have been responsible for the other three deaths, two of which were unwitnessed. Sudden death in people with epilepsy is an entity of great concern. Appropriate death certification and mandatory postmortem examination are essential to provide a truer picture of this neglected phenomenon.

[1]  J. A. Levisky,et al.  Premature deaths in persons with seizure disorders--subtherapeutic levels of anticonvulsant drugs in postmortem blood specimens. , 1978, Journal of forensic sciences.

[2]  V. Hachinski,et al.  Cerebrogenic Cardiac Arrhythmias: Cerebral Electrocardiographic Influences and Their Role in Sudden Death , 1990 .

[3]  M. Caria,et al.  Analysis of central cardioarrhythmogenic triggers in experimental epilepsy , 1990, Epilepsy Research.

[4]  W. Hauser,et al.  Mortality in Patients with Epilepsy , 1980, Epilepsia.

[5]  M. Brodie,et al.  Antiepileptic Drug Monitoring at the Epilepsy Clinic: A Prospective Evaluation , 1991, Epilepsia.

[6]  W. Hauser,et al.  ECG abnormalities in patients with epilepsy , 1987, Neurology.

[7]  S. Ladefoged,et al.  Cardiac conduction disturbances during carbamazepine therapy , 1983, Acta neurologica Scandinavica.

[8]  A. Unger,et al.  Fatalities following intravenous use of sodium diphenylhydantoin for cardiac arrhythmias. Report of two cases. , 1967, JAMA.

[9]  H. Gormsen,et al.  The role of antiepileptics in sudden death in epilepsy , 1985, Acta neurologica Scandinavica.

[10]  D. Chadwick,et al.  Sudden death and epilepsy , 1990, The Lancet.

[11]  C. Lathers,et al.  Psychoactive Agents, Seizure Production, and Sudden Death in Epilepsy , 1987, Journal of clinical pharmacology.

[12]  Massey Ew,et al.  Mortality from Epilepsy , 1985 .

[13]  A. Damato,et al.  The antiarrhythmic actions of carbamazepine (Tegretol). , 1970, The Journal of pharmacology and experimental therapeutics.

[14]  R. Homan,et al.  Kindled Seizures Elevate Blood Pressure and Induce Cardiac Arrhythmias , 1990, Epilepsia.

[15]  D. Hamilton CARBAMAZEPINE AND HEART BLOCK , 1978, The Lancet.

[16]  M. Iivanainen,et al.  Causes of Death in Institutionalized Epileptics , 1979, Epilepsia.

[17]  W. Hauser,et al.  Heart Disease Mortality and Morbidity in Patients with Epilepsy , 1984, Epilepsia.

[18]  Jay Gw,et al.  Sudden death in epilepsy. A comprehensive review of the literature and proposed mechanisms. , 1981 .

[19]  J. Troncoso,et al.  Evaluation of Sudden Death in Epilepsy , 1986, The American journal of forensic medicine and pathology.

[20]  L. D. Blumhardt,et al.  ELECTROCARDIOGRAPHIC ACCOMPANIMENTS OF TEMPORAL LOBE EPILEPTIC SEIZURES , 1986, The Lancet.

[21]  A. Plesner,et al.  Epilepsy in the elderly: life expectancy and causes of death , 1987, Acta neurologica Scandinavica.

[22]  J E Leestma,et al.  A prospective study on sudden unexpected death in epilepsy , 1989, Annals of neurology.

[23]  C. Lathers,et al.  The role of enkephalins in the production of epileptogenic activity and autonomic dysfunction: origin of arrhythmia and sudden death in the epileptic patient? , 1987, Medical hypotheses.

[24]  J. Rajs,et al.  Post-mortem findings of cardiac lesions in epileptics: a preliminary report. , 1976, Forensic science.

[25]  C. S. Hirsch,et al.  Unexpected death in young epileptics , 1971, Neurology.

[26]  W. Hauser,et al.  Ischemic Heart Disease in Patients with Epilepsy , 1976, Epilepsia.

[27]  R. Dasheiff,et al.  Sudden unexpected death of epileptic patient due to cardiac arrhythmia after seizure. , 1986, Archives of neurology.

[28]  P. Satishchandra,et al.  Case-control study of associated conditions at the time of death in patients with epilepsy. , 1988, Neuroepidemiology.

[29]  P. Schraeder,et al.  Paroxysmal autonomie dysfunction, epileptogenic activity and sudden death , 1989, Epilepsy Research.