Sudden unexpected death in epilepsy: a retrospective analysis of 24 adult cases.
ABSTRACT Sudden unexpected death in epilepsy is a common form of seizure-related death but is poorly appreciated by the medical profession. A number of risk factors have been identified in this context including male gender, young adult age group (20-40 years), poor compliance with antiepileptic drugs, polytherapy, and presence of neuropathological lesions. In addition it has been noted that most of the victims sustained an unwitnessed collapse at home. In this paper, we describe a retrospective review of 24 adult cases of sudden unexpected death in epilepsy. The study recognizes two risk factors; poor compliance with anti-epileptic monotherapy and an age between 20 and 29 years. All the victims were found dead at home and only one had a witnessed collapse. Our study shows a variety of neuropathological findings as the etiology. The completeness of the autopsy findings for all the cases is a strength compared to some of the other studies.
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ABSTRACT: Sudden unexpected deaths in epileptic persons are not rare events, most commonly encountered by the forensic pathologist rather than the clinician. Such deaths may represent 1-1.5% of all "natural" deaths certified by the medical examiner or coroner. The typical victim is a black male about 30 years of age who tends to abuse alcohol, with a history of generalized epilepsy for more than 1 year and likely for more than 10 years. There are a lack of obvious anatomic causes for the death at autopsy, but 60-70% of cases will have a lesion in the brain (most commonly old trauma) to explain the epilepsy. Most victims have no blood levels of anticonvulsant medications at the time of death. We have evolved a form for use by medical examiner/coroner's investigators at the scene to collect relevant information which will be of assistance to the pathologist in interpreting the case. Estimated prevalence of sudden epilepsy death, mechanisms, and other features of such cases are reviewed briefly.American Journal of Forensic Medicine & Pathology 10/1985; 6(3):215-8. · 0.88 Impact Factor
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ABSTRACT: Sudden unexpected death accounts for a substantial portion of deaths among epileptics. The incidence of this phenomenon is probably 1 in 370 to 1 in 1,110 in the general epileptic population but may be even higher in the 20- to 40-year age group, and still higher if epileptics with symptomatic epilepsy are selected. Sudden unexpected death in epileptics has been observed at least once weekly by the Office of the Medical Examiner of Cook County (Chicago), Illinois, for many years. A year-long prospective study revealed that victims of this complication of epilepsy are most commonly black males averaging 35 years of age who have infrequent generalized seizures and usually have some structural lesion in the brain responsible for their seizures. They tend to abuse alcohol and have poor compliance with anticonvulsant medication. The electroencephalograms display considerable variability from record to record. At autopsy the heart, lung, and liver weights were heavier and the brain weights were lighter than expected. The mechanisms involved in sudden unexpected death in epileptics may include autonomically mediated cardiac arrhythmia alone or in combination with sudden "neurogenic" pulmonary edema and "backward" cardiac failure.Annals of Neurology 09/1989; 26(2):195-203. · 11.19 Impact Factor
- Epilepsia 07/1974; 15(2):191-201. · 3.91 Impact Factor