Individuals with epilepsy have a mortality rate 2 to 3 times that of the general population, attributable both to any underlying disease that may be causing epilepsy and to the epilepsy itself. The commonest category of seizure-related death is sudden unexpected death in epilepsy (SUDEP).The epidemiology of SUDEP has been extensively studied and a number of such studies have taken anticonvulsant drug usage as an indicator of epilepsy, although obviously this may lead to inaccuracies. Epidemiological work has also yielded information about possible risk factors for SUDEP. At present there is no evidence that any particular anticonvulsant influences this risk, although there are anecdotal reports of sinus arrest and arrhythmias occurring in individuals receiving carbamazepine. A recent case-control study found that the risk of SUDEP increased with increasing number of concomitant anticonvulsants. In many cases of SUDEP, subtherapeutic anticonvulsant concentrations have been found at postmortem which may reflect noncompliance with medication, although the relationship between ante- and postmortem drug concentrations is unclear.The mechanism of SUDEP is unknown, although a possible role for anticonvulsants in its aetiology must be considered. Some anticonvulsants, by blocking sodium channels, have a direct effect on cardiac conduction, but studies examining the association between anticonvulsants and cardiac arrhythmia are lacking.As there is evidence to suggest an association between seizures and sudden death, the judicious use of anticonvulsants in optimising seizure control may be important in the prevention of these deaths.
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