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**7** 

 *Brasil* 

**Sudden Unexpected Death in** 

 *Universidade de São Paulo. Ribeirão Preto, São Paulo,* 

*Escola Paulista de Medicina (UNIFESP/EPM), São Paulo,* 

*1Centro de Cirurgia de Epilepsia (CIREP). Departamento de Neurociências e Ciências do Comportamento. Faculdade de Medicina de Ribeirão Preto,* 

*2Disciplina de Neurologia Experimental. Universidade Federal de São Paulo,* 

Epilepsy is one of the most frequent neurological disorders, both in children and adult persons. About 0.5-1% of general population suffer from epilepsy, which means that 50 million people in the world are affected. First years of life and very late adulthood are periods in human's life particularly predisposing to developing epilepsy. Patients with repetitive seizures may have a significantly lower quality of life, with frequent absences from work or school caused by seizures, difficulties in social life, frequent injuries, necessity of polytherapy and the risk of life-threatening situations, such as status epilepticus (Józwiak, 2007). People with epilepsy have also a two to three fold increased risk of death as compared to the age-matched general population and may die unexpectedly without a clear structural or pathologic identifiable cause. Increased risk of death primarily affects young adults mostly with drug resistant epilepsy and accounts for a large proportion of deaths among people with epilepsy.

SUDEP is defined as sudden, unexpected, witnessed or unwitnessed, non-traumatic and non-drowning death in patients with epilepsy, with or without the evidence of a seizure, excluding *status epilepticus*, and without a toxicological or anatomical cause of death in *postmortem* examination (Tomson et al, 2008). Diagnosis of SUDEP is sometimes difficult since *post-mortem* examination is not always available. Annegers (1997) suggested six criteria to consider the etiology of death as being SUDEP: 1. The diagnosis of epilepsy; 2. Death in a victim in a reasonable state of health; 3. Death should occur suddenly; 4. During normal activities and in benign circumstances; 5. Without a medical cause; 6. Not directly caused by a seizure or *status epilepticus* (Annegers, 1997). In this way, definite SUDEP cases need to have a *post-mortem* examination to ensure patient did not have a concomitant disease that can justify death and probable cases are considered that with clinical findings suggestive of SUDEP but where necropsy is not available. These strict criteria may hamper the diagnosis of SUDEP in many cases and, in these lines, other authors suggest that a formal *post-mortem* examination may be replaced by a verbal autopsy, contributing to a more realistic

This condition is called sudden unexpected death in epilepsy (SUDEP).

assessment of SUDEP incidence (Lathers & Schraeder, 2009).

**1. Introduction** 

**Epilepsy: An Overview** 

Vera C. Terra1, Américo C. Sakamoto1, Hélio R Machado1 and Fulvio A. Scorza2

seizures and generalized epilepsy associated with a mutation in the Na+-channel beta1 subunit gene SCN1B. *Nat Genet*, Vol. 19, (1998/08/11), pp. 366-370, ISSN 1061-4036

