Table 1

SUDEP preventative strategies

Mechanism/risk factorEvidence-based SUDEP preventative strategyPotential SUDEP preventative strategyComment
EpilepsyAEDs18Newer AEDsSevenfold decrease in SUDEP risk with AEDS
Intractable epilepsy
 Surgical candidateTemporal lobectomy for TLE100Other surgical epilepsy proceduresIf surgery eliminates seizures, SUDEP risk decreases dramatically
 Non-surgical candidateAEDs18Newer AEDsVNS decreases seizure frequency; may also have autonomic effects on heart
Seizure-induced hypoventilation/apnoeaPulse oxygenation alarms; seizure alarmsDevelopment of practical, portable, wearable ‘pulse ox’
Loss of arousalSupervision14Seizure alarms—wearable, bedSupervision allows for repositioning to optimise breathing
Prone/face downSpecial bedding; sleeping supinePrevents asphyxia, allows for greater chest wall movement
Sleep/sleep apnoeaSupervision at night14OSA treatment; CPAP; Implantable upper airway stimulatorUpper airway stimulation experimental
Intrinsic pulmonary dysfunctionMedical management
Seizure-induced cardiac arrhythmias/asystoleAICDAICDPacemakers prevent ictal asystole-induced syncope; however, not shown to prevent SUDEP
Intrinsic cardiac dysfunction/acquired autonomic dysfunctionVN; optimise cardiac function
Congenital LQTSMedical management; AICD
  • AED, anti-epileptic drug; AICD, automatic implantable cardioverter-defibrillator; CPAP, continuous positive airway pressure; LQTS, long QT syndrome; OSA, obstructive sleep apnoea; SUDEP, sudden unexpected death in epilepsy; TLE, temporal lobe epilepsy; VNS, vagal nerve stimulation.