Sudden Unexpected Death in Epilepsy: a Case Scenario to elaborate the need of awareness and a protocol for local setup

Abstract

Sudden unexpected death in epilepsy (SUDEP) is the commonest cause of death related to epilepsy. There is no settled proposition among neurologists, neuropathologists and forensic pathologists as to the exact pathophysiology of SUDEP. Though there is renowned interest about this entity in the developed world, there is little awareness and interest about SUDEP in the developing world. In the developed countries there are established SUDEP awareness programmes run by the state and other scientific organizations. They help in increasing the awareness of this entity among the general public, ensuring safety and well-being of the diagnosed epileptic patients and updating the knowledge among the clinicians and other academics. It is the authors’ view that the judicial medical officers in Sri Lanka too owe a similar responsibility and obligation towards the clinicians and the general public regarding raising the awareness of SUDEP and establishing a clinico-pathologic correlation. Diagnosis of SUDEP is a challenge in forensic pathology. It needs careful exclusion of suicidal, homicidal and accidental circumstances as well as other possible natural causes. This warrants careful study of the scene, history from several sources, meticulous autopsy examination followed by routine and ancillary investigations. We present a case report of SUDEP highlighting some of the deficiencies in Sri Lanka including the absence of a protocol to ensure quality-assured minimal standards in the investigation of suspected SUDEP cases.