Sudden unexpected death in epilepsy: are we missing it?

The investigation of sudden unexpected death lies at the core of practice of forensic pathology. It is well established that people with epilepsy have an increased risk of unexpected death. They experience sudden unexpected death two to three times that of general population. The incidence of SUDEP (sudden unexpected death in epilepsy) itself ranges from 1 to 2 per 1000 patients years. Many times, the autopsy is negative, and if there is not a more convincing cause of death, the individual's demise is usually attributed to the terminal seizure associated with autonomic cardiac and/or respiratory dysfunction. Although the exact mechanism of death from a terminal seizure is not definitively known, seizures are known to disrupt autonomic nervous system function and have been known to induce dangerous tachyarrhythmias, bradyarrhythmias, and asystole.