Sudden Unexpected Death in Epilepsy (SUDEP)

Sudden unexpected death in epilepsy (SUDEP) is a common cause of premature mortality among people with epilepsy (PWE). The overall incidence rate of SUDEP is around 1.2 per 1000 person-years overall, although this may vary across different populations. SUDEP represents a significant public health burden as PWE experience a higher mortality risk compared to the general population. This chapter aims to discuss the latest advancements in risk factors, mechanisms underlying SUDEP, and possible strategies to prevent its occurrence.Multiple risk factors have been proposed to contribute to an increased SUDEP risk, including high generalized tonic-clonic seizure (GTCS) frequency, treatment adherence, age of epilepsy onset, alcohol abuse, sleeping in a prone position, and intellectual disability. However, the interpretation of studies investigating risk factors remains a challenge due to variations in methodologies and populations. Despite the complexity of SUDEP, various mechanisms have been proposed. Postictal generalized EEG suppression (PGES) and impairment in serotonin modulation reflect dysfunctions in the brainstem, which may affect autonomic functions. Alterations in cardiorespiratory function, including bradycardia, hypoxemia, and apnea, have also been proposed as mechanisms of SUDEP. Controlling seizures may help to prevent SUDEP since high GTCS frequency is known to be a prominent risk factor. By providing more information about the risk of SUDEP, patients and caregivers can be empowered to adopt behavioral modifications for prevention. While other preventive measures have also been explored, such as nocturnal supervision, seizure alarms, and anti-suffocation pillows, whether or not these are effective in preventing SUDEP remains a debate.