Sudden unexpected death in epilepsy (SUDEP): clinical features

Evidence-based neurology checklist on sudden unexpected death in epilepsy (sudep): clinical features: Types Definite SUDEP Definite SUDEP plus: there is a concomitant condition identified before or at death Probable SUDEP or SUDEP plus: this is when a post-mortem was not performed Possible SUDEP:…

Types

  • Definite SUDEP
  • Definite SUDEP plus: there is a concomitant condition identified before or at death
  • Probable SUDEP or SUDEP plus: this is when a post-mortem was not performed
  • Possible SUDEP: this is when there are alternative competing causes of death
  • Near SUDEP or SUDEP plus: this is when resuscitation reverses cardiorespiratory arrest
  • Not SUDEP: this is when an alternative cause of death was confirmed
  • Unclassified: this is when there is incomplete information to enable classification

Definitive features

Pre-ictal respiratory features

Pre-ictal cardiac features

Ictal features

Post-ictal (terminal) cardiorespiratory features

Differential diagnosis

References

  1. Devinsky O, Hesdorffer DC, Thurman DJ, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol 2016; 15:1075-1088. 
  2. Nashef L, So EL, Ryvlin P, Tomson T. Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia 2012; 53:227-233.
  3. Smithson WH, Colwell B, Hanna J. Sudden unexpected death in epilepsy: addressing the challenges. Curr Neurol Neurosci Rep 2014; 14:502.
  4. Picard RW, Migliorini M, Caborni C, et al. Wrist sensor reveals sympathetic hyperactivity and hypoventilation before probable SUDEP. Neurology 2017; 89:633-635.
  5. Myers KA, Bello-Espinosa LE, Symonds JD, et al. Heart rate variability in epilepsy: a potential biomarker of sudden unexpected death in epilepsy risk. Epilepsia 2018; 59:1372-1380.
  6. And 7 more. Subscribe to see the full list

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