Premature Mortality and Sudden Unexpected Death in Epilepsy

People with epilepsy are at a significantly elevated risk of premature mortality globally, particularly in resource-poor settings. While direct epilepsy-related deaths, such as accidents, status epilepticus, and sudden unexpected death in epilepsy (SUDEP), account for a smaller proportion overall, this rises to over a third of people who have drug-resistant epilepsy (DRE). In high-income countries, SUDEP is the leading cause of epilepsy-related death in people with DRE. It is second only to stroke among neurological conditions in years of potential life lost. Key risk factors for SUDEP include frequent convulsions, intellectual disability, and nocturnal seizures. Cardiorespiratory mechanisms, genetic predispositions, and structural brain alterations are increasingly recognised in SUDEP pathophysiology. Prevention requires a holistic approach that focuses on seizure control, comorbidity management, lifestyle modifications, and effective risk communication.