الفهرس 
Overview on Mortality in EpilepsyOnly 14 pages are availabe for public view
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Abstract
Epilepsy is associated with 2-3 folds increased mortality compared with age matched population. Sudden Unexpected death in Epilepsy (SUDEP) is the commonest cause of death in patients with refractory epilepsy.
The most significant risk factor associated with SUDEP is epilepsy severity in term of seizure frequency, epilepsy duration and poor control by AED therapy. Most cases had GTC fits as the type of seizure. Other risk factors include male gender, young age with peak of onset at age 25-39, comorbid cardiac disease and rapid AED withdrawal. Most SUDEP cases were found dead in bed suggesting possible role for sleep in pathomechanisms of SUDEP. No specific AED was associated with increased SUDEP risk and there has been conflicting data regarding association of focal CNS lesion with increased risk.
Suggested Underlying pathomechanisms of SUDEP include cardiac pathomechanisms as seizure induced tachyarrythmias or bradyarrhythmias, seizure induced respiratory dysfunction, brains stem respiratory center suppression and prolonged postictal cerebral electrical shutdown. Neuroinflammation may play a role in SUDEP yet this has not yet been confirmed.
Proposed SUDEP preventive measures include ensuring adequate seizure control, interventions targeted at improving AED adherence, epilepsy surgery in medically refractory patients with epilepsy, adequate supervision with monitoring via new extracerebral methods for seizure detection in high risk cases and cardiac intervention in selected cases. Beta blockers have been suggested to play a role in SUDEP prevention though there are no formal recommendations regarding this issue. Omega three fatty acid supplements may also play a role on SUDEP prevention.
Discussing risk of sudden death with epileptic patients is a difficult task facing every clinician caring for epileptic patients. Despite controversy regarding routine discussion, most authorities recommend discussion of SUDEP risk as a part of a comprehensive epilepsy education program.