SUDEP

What is SUDEP?
SUDEP, or Sudden, Unexplained Death in EPilepsy, occurs when a patient with epilepsy dies suddenly and with no apparent cause. SUDEP occurs in approximately 1/1000 patients with drug-resistant epilepsy.

General Risk Factors
- Severity of seizures
- Skipping drug doses (poor compliance)*
- Taking multiple anticonvulsant drugs*
- Breathing complications (eg, apnea)
- Having a structural brain lesion
- Cardiac abnormalities (eg, irregular heart beat)
- Being male (males are affected by SUDEP more commonly than females)

*These do not appear to be significant risk factors for SUDEP in children.

SUDEP Prevention
Aggressively Pursue Seizure Control
This may sound like one of those "duhhhh of course" statements, but many people stop short of exhausting their treatment options.
First and foremost, take your anticonvulsant medications as prescribed. If you are unclear about how you should be taking your medications then please talk to your pharmacist.
If you have uncontrolled seizures, make sure you see an epileptologist. Also, don’t be afraid to get a second opinion or a referral to a well established epilepsy treatment center-- it's your right. Read the "see an epileptologist" post below to find out where your nearest epilepsy treatment centre is.
Don’t be afraid to consult all forms of health care specialists (eg, naturopathic doctors).

**Make sure you consult your pharmacist before taking any other drugs and/or herbs. Some drugs and herbs can significantly impact how your body metabolizes/eliminates the drugs you are currently taking.

Sleep on Your Back
Breathing complications, especially during sleep, are thought to be a contributor to both SIDS (Sudden Infant Death Syndrome) and SUDEP. Studies have shown that SUDEP is significantly less common in individuals who sleep on their backs (ie, face up) than those who sleep on their stomach (ie, face down).

Check Your Heart
Abnormalities in heart function have been correlated with a higher risk of SUDEP. "Prolonged QT interval" (this basically means your heart beat is a bit abnormal) is a risk factor in SUDEP. Another cardiac phenomenon that is linked to SUDEP is "syncope", which is when one feints due to a lack of blood to the brain. It is well worth having your heart checked (quick and easy), especially if an individual has several of the general risk factors outlined above.

Check Your Stress
This "S-word" seems to be implicated in several disorders; epilepsy and SUDEP are no exception. Stress and anxiety can contribute to elevated adrenaline (also called: epinephrine) levels in the body. Adrenaline makes the heart pump faster, which can exacerbate any pre-existing heart abnormalities and contribute to increased risk of SUDEP. As a general health tip, try to avoid significant sources of stress in your life. When unavoidable, try to find ways to minimize the impact of these stressors. Soothing music, relaxed and deep breathing, massage, yoga, diverting your mind with fun (play games, sports) are different things one can to do to minimize stress.

Conclusions
Not all of the causes of SUDEP are understood but certain risk factors have been identified. We may not eliminate SUDEP, but we can take relatively small actions to minimize their risk of SUDEP.

References:
Donner EJ et al., 2001. Neurology. 57:430-434.
Nashef L et al., 2007. Epilepsia. 48: 859–871.
Lathers et al., 2008. Epilepsy and Behavior. 12: 3-24.