Why Can Some Epileptic Seizures Lead to Sudden Death

People with epilepsy face an increased risk of premature death, particularly due to a phenomenon known as sudden and unexpected death. This risk is up to twenty-four times higher than in the general population. Each year, about one in a thousand people is affected, but this figure can exceed one in a hundred among those with severe or treatment-resistant epilepsy. Over a lifetime, the cumulative risk averages five to twenty percent.

Generalized tonic-clonic seizures, especially when they occur at night, are the main risk factor. Other factors such as living alone, a long duration of the disease, or difficult-to-control epilepsy also increase this danger. The exact mechanisms remain poorly understood, but recent research suggests that a malfunction in waking up after a seizure could cause apnea, followed by a slowdown of the heart until it stops.

Certain areas of the brain, such as the brainstem, play a key role in regulating breathing and heart rate. Impairment of these functions, combined with poor recovery after a seizure, appears to trigger a fatal cascade. Sleep disorders and irregular breathing during the night are also identified warning signs.

Children with severe forms of epilepsy, such as Dravet syndrome, are particularly vulnerable. In these cases, the risk is already high in childhood, with a quarter of cases occurring before the age of twenty. Adults aged twenty to forty-nine are the most affected, often during sleep and while lying on their stomach.

Prevention relies primarily on good seizure control, especially at night. Sharing a room with someone who can intervene or using monitoring devices can reduce the risks. Modern drug treatments, by improving seizure control, have also shown a decrease in unexpected deaths.

Recent studies have highlighted the importance of sleep quality and breathing. Disrupted sleep architecture or frequent apneas worsen the risks. Researchers are also exploring genetic leads and targeted interventions to better protect the most exposed patients.

Even though progress has been made, every person with epilepsy retains a residual risk. Tailored management and clear information for patients and their loved ones remain essential to limit these tragedies.

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Reference Document

DOI: https://doi.org/10.1186/s42466-026-00480-w

Title: Current perspectives in sudden unexpected death in epilepsy (SUDEP): epidemiology, research approaches and pathways to prevention

Journal: Neurological Research and Practice

Publisher: Springer Science and Business Media LLC

Authors: Catrin Mann; Susanne Schubert-Bast; Felix Rosenow; Adam Strzelczyk