Among patients with seizures and epilepsy who die suddenly, seizures and sudden unexpected deaths in epilepsy (SUDEP) often go unrecognized as a potential or definite cause of death (COD), a recent study found. Researchers compared prospective seizure or epilepsy diagnosis and final COD as adjudicated by a multidisciplinary committee (pathologists, electrophysiologists, and a vascular neurologist) vs retrospective adjudication by 2 epileptologists with expertise in seizure-related mortality. They found:

• Of 541 sudden cardiac deaths (SCDs) identified during the 37-month study period (mean age 62.8 years, 69% men), 525 (97%) were autopsied; 39/525 (7.4%) had seizures or epilepsy (mean age: 58 years, range: 27–92; 67% men), comprising 17% of 231 nonarrhythmic sudden deaths.
• The multidisciplinary team identified 15 cases of epilepsy, 6 SUDEPs, and no deaths related to acute symptomatic seizures.
• The epileptologists identified 25 cases of epilepsy and 8 definite SUDEPs, 10 possible SUDEPs, and 5 potential cases of acute symptomatic seizures as a COD.