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Sudden unexpected death in epilepsy: basic mechanisms and clinical implications for prevention
  1. Brian J Dlouhy1,
  2. Brian K Gehlbach2,
  3. George B Richerson3,4,5
  1. 1Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
  2. 2Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
  3. 3Department of Neurology, University of Iowa, Iowa City, Iowa, USA
  4. 4Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA
  5. 5Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Brian J Dlouhy, Department of Neurosurgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242, USA; brian-dlouhy{at}


Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in patients with intractable epilepsy. The substantial lifetime risk of SUDEP and the lack of a clear pathophysiological connection between epilepsy itself and sudden death have fuelled increased attention to this phenomenon. Understanding the mechanisms underlying SUDEP is paramount to developing preventative strategies. In this review, we discuss SUDEP population studies, case–control studies, witnessed and monitored cases, as well as human seizure cardiorespiratory findings related to SUDEP, and SUDEP animal models. We integrate these data to suggest the most probable mechanisms underlying SUDEP. Understanding the modifiable risk factors and pathophysiology allows us to discuss potential preventative strategies.


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