Every year, 5000 people with epilepsy die of sudden, unexpected death (SUDEP) in the United States alone. This is a twenty-fold increased risk compared to the general population. Risk factors are young men who are noncompliant and have uncontrolled generalized tonic-clonic (grand mal) seizures. The longstanding theory was that since epilepsy comes from the brain, the cause must be in the brain. A new study, however, points to the fact that SUDEP is associated with a higher prevalence of congenital / inherited heart disease such as prolonged QT syndrome and hypertrophic cardiomyopathy. These disorders are recognized to cause sudden death in young athletes who do not have epilepsy. Should all young patients with epilepsy be screened with an EKG and an echocardiogram?

Jack Florin, MD

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