Mortality
Mortality as a result of epilepsy is a significant concern. It is
two to fours times more common than for children without
epilepsy. This risk is highest among children and young adults.
Death in a child with epilepsy may be because of the following:
■■An underlying cause, such as neurodegenerative disorder
■■Accident during epileptic seizure (trauma, drowning,
aspiration, suffocation)
■■ Status epilepticus
■■ Suicide
■■ Sudden death in epilepsy (SUDEP), defined as sudden,
unexpected, non-traumatic and non-drowning death in an
individual with epilepsy in which autopsy does not reveal
an anatomical or toxicological cause of the death. SUDEP
causes about 500 deaths each year in the UK (Epilepsy
Research UK, 2011). Criteria for the diagnosis of SUDEP
are:
■■Patient has epilepsy—i.e. recurrent, unprovoked seizures
■■Patient died unexpectedly while in reasonable health
■■Death occurred suddenly, within minutes
■■Death occurred without suspicious circumstances
■■Death was not a direct result of seizure or status epilepticus
■■An obvious medical cause could not be determined at
autopsy.
Factors associated with an increased risk of mortality include:
■■ Symptomatic epilepsy (e.g. cerebral malformation,
developmental delay)
■■Uncontrolled generalised tonic-clonic seizures
■■Patients with sleep seizures
■■Poor compliance with AEDs
■■ Sudden and frequent changes to AEDs and treatment with
more than two AEDs (Walczak et al, 2001)
■■Lack of sleep or food, stress, excess alcohol intake
■■ Seizure occurrence when alone or li