PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jrsocmedLink to Publisher's site
 
J R Soc Med. 1992 October; 85(10): 609–611.
PMCID: PMC1293687

Sudden death in epilepsy: an avoidable outcome?

Abstract

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.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (643K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Hauser WA, Annegers JF, Elveback LR. Mortality in patients with epilepsy. Epilepsia. 1980 Aug;21(4):399–412. [PubMed]
  • Jay GW, Leestma JE. Sudden death in epilepsy. A comprehensive review of the literature and proposed mechanisms. Acta Neurol Scand Suppl. 1981;82:1–66. [PubMed]
  • Lühdorf K, Jensen LK, Plesner AM. Epilepsy in the elderly: life expectancy and causes of death. Acta Neurol Scand. 1987 Sep;76(3):183–190. [PubMed]
  • Annegers JF, Hauser WA, Shirts SB. Heart disease mortality and morbidity in patients with epilepsy. Epilepsia. 1984 Dec;25(6):699–704. [PubMed]
  • Hirsch CS, Martin DL. Unexpected death in young epileptics. Neurology. 1971 Jul;21(7):682–690. [PubMed]
  • Schwender LA, Troncoso JC. Evaluation of sudden death in epilepsy. Am J Forensic Med Pathol. 1986 Dec;7(4):283–287. [PubMed]
  • Schraeder PL, Lathers CM. Paroxysmal autonomic dysfunction, epileptogenic activity and sudden death. Epilepsy Res. 1989 Jan-Feb;3(1):55–62. [PubMed]
  • Leestma JE, Walczak T, Hughes JR, Kalelkar MB, Teas SS. A prospective study on sudden unexpected death in epilepsy. Ann Neurol. 1989 Aug;26(2):195–203. [PubMed]
  • Brown SW, Mawer GE, Lawler W, Taylor DC, Shorvon S, Betts TA, Noronha MJ, Richens A, Chadwick D, Besag FM, et al. Sudden death and epilepsy. Lancet. 1990 Mar 10;335(8689):606–607. [PubMed]
  • Lipka LJ, Lathers CM. Psychoactive agents, seizure production, and sudden death in epilepsy. J Clin Pharmacol. 1987 Mar;27(3):169–183. [PubMed]
  • Mameli O, Mameli P, Tolu E, Padua G, Melis F, Caria MA, Virdis A. Analysis of central cardioarrhythmogenic triggers in experimental epilepsy. Epilepsy Res. 1990 Dec;7(3):210–218. [PubMed]
  • Goodman JH, Homan RW, Crawford IL. Kindled seizures elevate blood pressure and induce cardiac arrhythmias. Epilepsia. 1990 Sep-Oct;31(5):489–495. [PubMed]
  • Annegers JF, Elveback LR, Labarthe DR, Hauser WA. Ischemic heart disease in patients with epilepsy. Epilepsia. 1976 Mar;17(1):11–14. [PubMed]
  • Kraras CM, Tumer N, Lathers CM. The role of enkephalins in the production of epileptogenic activity and autonomic dysfunction: origin of arrhythmia and sudden death in the epileptic patient? Med Hypotheses. 1987 May;23(1):19–31. [PubMed]
  • Keilson MJ, Hauser WA, Magrill JP, Goldman M. ECG abnormalities in patients with epilepsy. Neurology. 1987 Oct;37(10):1624–1626. [PubMed]
  • Blumhardt LD, Smith PE, Owen L. Electrocardiographic accompaniments of temporal lobe epileptic seizures. Lancet. 1986 May 10;1(8489):1051–1056. [PubMed]
  • Dasheiff RM, Dickinson LJ. Sudden unexpected death of epileptic patient due to cardiac arrhythmia after seizure. Arch Neurol. 1986 Feb;43(2):194–196. [PubMed]
  • Oppenheimer SM, Cechetto DF, Hachinski VC. Cerebrogenic cardiac arrhythmias. Cerebral electrocardiographic influences and their role in sudden death. Arch Neurol. 1990 May;47(5):513–519. [PubMed]
  • Satishchandra P, Chandra V, Schoenberg BS. Case-control study of associated conditions at the time of death in patients with epilepsy. Neuroepidemiology. 1988;7(3):109–114. [PubMed]
  • Falconer B, Rajs J. Post-mortem findings of cardiac lesions in epileptics: a preliminary report. Forensic Sci. 1976 Jul-Aug;8(1):63–71. [PubMed]
  • Lund A, Gormsen H. The role of antiepileptics in sudden death in epilepsy. Acta Neurol Scand. 1985 Oct;72(4):444–446. [PubMed]
  • Iivanainen M, Lehtinen J. Causes of death in institutionalized epileptics. Epilepsia. 1979 Oct;20(5):485–491. [PubMed]
  • Unger AH, Sklaroff HJ. Fatalities following intravenous use of sodium diphenylhydantoin for cardiac arrhythmias. Report of two cases. JAMA. 1967 Apr 24;200(4):335–336. [PubMed]
  • Steiner C, Wit AL, Weiss MB, Damato AN. The antiarrhythmic actions of carbamazepine (Tegretol). J Pharmacol Exp Ther. 1970 Jun;173(2):323–335. [PubMed]
  • Hamilton DV. Carbamazepine and heart block. Lancet. 1978 Jun 24;1(8078):1365–1365. [PubMed]
  • Boesen F, Andersen EB, Jensen EK, Ladefoged SD. Cardiac conduction disturbances during carbamazepine therapy. Acta Neurol Scand. 1983 Jul;68(1):49–52. [PubMed]
  • Bowerman DL, Levisky JA, Urich RW, Wittenberg PH. Premature deaths in persons with seizure disorders--subtherapeutic levels of anticonvulsant drugs in postmortem blood specimens. J Forensic Sci. 1978 Jul;23(3):522–526. [PubMed]
  • Larkin JG, Herrick AL, McGuire GM, Percy-Robb IW, Brodie MJ. Antiepileptic drug monitoring at the epilepsy clinic: a prospective evaluation. Epilepsia. 1991 Jan-Feb;32(1):89–95. [PubMed]
  • Massey EW, Schoenberg BS. Mortality from epilepsy. International patterns and changes over time. Neuroepidemiology. 1985;4(2):65–70. [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press