Risk Factors Associated with Sudden Unexpected Death in Epilepsy (Sudep): A Systematic Literature Review
DOI:
https://doi.org/10.47363/JIMRR/2025(4)142Keywords:
Epilepsy, SUDEP, Generalized Tonic-Clonic Crises, Adherence to Treatment, PreventionAbstract
Introduction: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in patients with epilepsy, particularly those with refractory forms. Mechanisms involve cardiovascular autonomic dysfunction linked to generalized tonic–clonic seizures (GTCS). Despite
the identification of multiple risk factors, methodological inconsistencies hinder generalization and development of effective preventive strategies.
Objectives: This review aims to identify and synthesize current evidence on risk factors associated with SUDEP, clarify discrepancies, detect knowledge gaps, and propose foundations for preventive clinical measures.
Methods: A systematic literature review was conducted in accordance with PRISMA guidelines. We included observational studies and clinical trials published in English or Spanish, retrieved from PubMed, Embase, and The Cochrane Library. Methodological quality was assessed using validated tools. Out of 348 records, 26 studies met the inclusion criteria.
Results: Recent GTCS episodes were strongly associated with higher SUDEP risk (OR = 26.81; 95% CI: 14.86–48.38). High seizure frequency and lack of night supervision increased the risk even further (OR = 67.10; 95% CI: 29.66–151.88). Poor adherence to antiepileptic treatment also emerged as a significant risk factor (OR = 2.75; 95% CI: 1.58–4.78).
Discussion: GTCS frequency and treatment adherence are critical in SUDEP risk. Implementing night monitoring and adherenceenhancing strategies may help reduce incidence. However, limitations such as heterogeneous SUDEP definitions and small sample sizes underline the need for robust, prospective research to refine prevention efforts.
