ABSTRACT
Epidemiological studies It is clear from outcome studies of epilepsy that more than 70% of all patients with epilepsy enter lasting remission from the condition and up to 30% suffer chronic seizures that are difficult to control. Approximately 1 out of every 200 such patients with chronic epilepsy die suddenly and unexpectedly every year. But how common is this phenomenon in the community where the majority of patients do not have difficult, intractable epilepsy? The National GP Study of Epilepsy in the UK (NGPSE), which is an observational study of epilepsy in the community,8 has had only one confirmed SUDEP death in a prospective cohort of 564 patients with definite epilepsy followed up for approximately 8000 person years.9 The MRC Antiepileptic Drug Withdrawal Study had just two deaths attributable to SUDEP after 5000 person years of follow-up.10 These figures are reflective of the relative rarity of this phenomenon in patients who do not have chronic epilepsy, as in the NGPSE almost 70% of the cohort had achieved 5-year remission from seizures.11 Similarly, the MRC study population was in remission and there is strong evidence that SUDEP is mainly a problem in the patient with intractable epilepsy.
