Sudden Death in Epilepsy: Forensic and Clinical Issues, 1st Edition (Hardback) book cover

Sudden Death in Epilepsy

Forensic and Clinical Issues, 1st Edition

Edited by Claire M. Lathers, Paul L. Schraeder, Michael W. Bungo, Jan E. Leestma

CRC Press

1,047 pages | 177 B/W Illus.

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Though it is one of the most common causes of death in epilepsy patients, SUDEP is still infrequently and even reluctantly named on autopsy reports. This under-reporting equates to a lack of attention and earnest investigation into the cause, predisposition, and prevention of SUDEP. There is as yet little effort to establish an actionable strategy in the mitigation of these potentially fatal arrhythmias.

Expanding on the 1990 book Epilepsy and Sudden Death, edited by Lathers and Schraeder, Sudden Death in Epilepsy: Forensic and Clinical Issues reviews of the basic science of epilepsy as it relates to SUDEP. Clinical chapters study the sophisticated simultaneous ambulatory EKG and EEG telemetry and respiratory function monitoring of patients at risk for sudden death that will help identify cardiac, respiratory, and epileptogenic interactions involved. Chapters on animal models evaluate new data from studies that build on previously used models and emphasize that multiple models are needed to investigate the pathophysiology of SUDEP, to hypothesize about effective treatments, to develop pilot studies in persons with epilepsy, and to conduct confirmatory large-scale clinical trials.

Contributions discuss the interaction between the central and peripheral autonomic nervous systems and the cardiopulmonary systems; proposed mechanistic factors in SUDEP; risk categories of arrhythmogenic, respiratory, and hypoxia related cardiac death; psychological, emotional, and stress related factors; the role of alcohol and drugs in seizures; and the potential mitigating properties of antiepileptic medication.

Adopting a global, multidisciplinary focus to address the mystery of SUDEP, this important work provides clinicians, researchers, patients, and families with the knowledge to freely discuss the phenomenon and thereby discover the preventive treatment regimens to decrease the occurrence of SUDEP.


Lathers and colleagues have produced a colossal and astonishingly comprehensive tome on a little-appreciated subject: sudden death in epilepsy (SUDEP). All physicians who have treated patients with severe epilepsy have experienced the anguish of losing a young patient to this ill-defined syndrome. This book addresses all the issues--from the clinical to the basic, from the forensic to the bereavement. Every physician who treats epilepsy will do well to draw from the extraordinary compilation of data and expertise in this volume.

—Roger J. Porter, MD, ScD, Adjunct Professor of Neurology, University of Pennsylvania, Philadelphia and Adjunct Professor of Pharmacology, USUHS, Bethesda

The book is a skilled amalgam of neuroscience, cardiology, and pharmacology, along with numerous illustrative case examples, and it will become much thumbed-through as it takes a place of prominence on this forensic pathologist’s bookshelf.

—Gregory J. Davis, MD, FCAP, University of Kentucky College of Medicine, State Medical Examiner, Kentucky, in Et Cetera.

Table of Contents

Forensics of Sudden Death

Neurocardiologic Mechanistic Risk Factors in Sudden Unexpected Death in Epilepsy: C.M. Lathers, P.L. Schraeder, and M.W. Bungo

Forensic Considerations and Sudden Unexpected Death in Epilepsy: J.E. Leestma

Omega-3 Fatty Acids in Sudden Unexpected Death in Epilepsy: Guardian of the Brain–Heart Connection: F.A. Scorza, E.A. Cavalheiro, R.M. Arida, V.C. Terra, C.A. Scorza, E.Y.F. Sonoda and R.M. Cysneiros

Unanswered Questions: SUDEP Studies Needed: C.M. Lathers, P.L. Schraeder and M.W. Bungo

Medullary Serotonergic Abnormalities in Sudden Infant Death Syndrome: Implications in SUDEP: D.S. Paterson

Forensic Case Identification: P.L. Schraeder, E.L. So and C.M. Lathers

Sudden Unexpected Death in Epilepsy: Future Research Directions: S. Parvulescu-Codrea

Forensic Postmortem Examination of Victims of Sudden Unexpected Death in Epilepsy: C.M. Lathers, P.L. Schraeder, S.A. Koehler and C.H. Wecht

One-Year Postmortem Forensic Analysis of Deaths in Persons with Epilepsy: S.A. Koehler, P.L. Schraeder, C.M. Lathers and C.H. Wecht

Drug Abuse and SUDEP: S.B. Karch

Cocaine-Induced Seizures, Arrhythmias, and Sudden Death: C.M. Lathers, M.M. Spino, I. Agarwal, L.S.Y. Tyau and W.B. Pickworth

Risk Factors for Sudden Death in Epilepsy: T. Walczak

EEG Findings in SUDEP: M. Nei and N. Simpkins

Severity of Seizures as a Forensic Risk and Case Reports: E.H. Maa, M.P. Earnest, M.C. Spitz and J. Bainbridge

Intractable Epilepsy in the Setting of Malformations of Cortical Development as a Mechanism for SUDEP: L. Jehi and I. Najm

Neurogenic Cardiac Arrhythmias: H. Leung and A.Y.Y. Chan

Stress and SUDEP:C.M. Lathers and P.L. Schraeder

Genetics of Sudden Death in Epilepsy: N. Ghali and L. Nashef

Cardiac Channelopathies and Sudden Death: B. Herreros

Sodium Channel Dysfunction Common Physiopathologic Mechanism Associated with Sudden Death ECG Abnormalities in Brugada Syndrome and Some Types of Epilepsy: Case Histories: C.M. Lathers, P.L. Schraeder and M.W. Bungo

Not Seizure but Syncope: S. Sharma, T. Ho and B.K. Kantharia

Syncope, Seizures, and SUDEP: Case Histories: C.M. Lathers, P.L. Schraeder and M.W. Bungo

Sudden Death in Epilepsy: Relationship to the Sleep–Wake Circadian Cycle and Fractal Physiology: J.D. Hughes and S. Sato

SUDEP: Medicolegal and Clinical Experiences: B.B. Wannamaker

SUDEP Animal Models


Sudden Death: Animal Models to Study Nervous System Sites of Action for Disease and Pharmacological Intervention: C.M. Lathers

Synaptic Plasticity of Autonomic Ganglia: Role of Chronic Stress and Implication in Cardiovascular Diseases and Sudden Death: K.A. Alkadhi and K.H. Alzoubi

Animal Model for Sudden Cardiac Death: Autonomic Cardiac Sympathetic Nonuniform Neural Discharge: C.M. Lathers

Animal Model for Sudden Unexpected Death in Persons with Epilepsy: C.M. Lathers and P.L. Schraeder

A Characterization of the Lockstep Phenomenon in Phenobarbital-Pretreated Cats: J.M. Dodd-O and C.M. Lathers

Relationship of the Lockstep Phenomenon and Precipitous Changes in Blood Pressure: A.Z. Stauffer, J.M. D.O and C.M. Lathers

Interspike Interval Histogram Characterization of Synchronized Cardiac Sympathetic Neural Discharge and Epileptogenic Activity in the Electrocorticogram of the Cat: D.K. O’Rourke and C.M. Lathers

Power Spectral Analysis: A Procedure for Assessing Autonomic Activity Related to Risk Factors for Sudden and Unexplained Death in Epilepsy: S.R. Quint, J.A. Messenheimer and M.B. Tennison

Animal Model for Sudden Cardiac Death: Sympathetic Innervation and Myocardial Beta-Receptor Densities: C.M. Lathers and R.M. Levin

Antiepileptic Activity of Beta-Blocking Agents: C.M. Lathers, K.F. Jim, W.H. Spivey, C. Kahn, K. Dolce and W.D. Matthews

Arrhythmias Associated with Epileptogenic Activity Elicited by Penicillin: C.M. Lathers and P.L. Schraeder

Role of Neuropeptides in the Production of Epileptogenic Activity and Arrhythmias: C.M. Lathers

Sudden Epileptic Death in Experimental Animal Models: O. Mameli and M.A. Caria

Sympathetic Nervous System Dysregulation of Cardiac Function and Myocyte Potassium Channel Remodeling in Rodent Seizure Models: Candidate Mechanisms for SUDEP: S.L. Bealer, C.S. Metcalf, J.G. Little, M. Vatta, A. Brewster and A. Anderson

The Urethane/Kainate Seizure Model as a Tool to Explore Physiology and Death Associated with Seizures: M. Stewart

Acute Cardiovascular Response during Kindled Seizures: J.H. Goodman, R.W. Homan and I.L. Crawford

DBA Mice as Models of Sudden Unexpected Death in Epilepsy: C.L. Faingold, S. Tupal, Y. Mhaskar and V.V. Uteshev

Clinical Issues of Sudden Death

Cardiac and Pulmonary Risk Factors and Pathomechanisms of Sudden Unexplained Death in Epilepsy Patients: J. Finsterer and C. Stöllberger

Neurocardiac Interactions in Sudden Unexpected Death in Epilepsy: Can Ambulatory Electrocardiogram-Based Assessment of Autonomic Function and T-Wave Alternans Help to Evaluate Risk?: R.L. Verrier and S.C. Schachter

Arrhythmogenic, Respiratory, and Psychological Risk Factors for Sudden Unexpected Death and Epilepsy: Case Histories: C.M. Lathers

Sudden Arrhythmic Death Syndrome: Underlying Cardiac Etiologies, Their Implications, and the Overlap with SUDEP: P.S. Dhillon and E.R. Behr

Odds Ratios Study of Antiepileptic Drugs: A Possible Approach to SUD EP Prevention?: C.M. Lathers, P.L. Schraeder and H.G. Claycamp

Antiepileptic Drugs Benefit/Risk Clinical Pharmacology: Possible Role in Cause and/or Prevention of SUDEP: C.M. Lathers and P.L. Schraeder

Clinical Pharmacology and SUDEP: C.M. Lathers and P.L. Schraeder

Experience-Based Teaching of Therapeutics and Clinical Pharmacology of Antiepileptic Drugs: Sudden Unexplained Death in Epilepsy: Do Antiepileptic Drugs Have a Role?: C.M. Lathers and P.L. Schraeder

Clinical Pharmacology of Antiepileptic Drug Use: Clinical Pearls about the Perils of Patty: P.L. Schraeder and C.M. Lathers

Compliance with Antiepileptic Drug Treatment and the Risk of Sudden Unexpected Death in Epilepsy: T. Tomson

SUDEP Clinical Case Histories: Typical and Atypical: P.L. Schraeder

Cardiac Antiarrhythmic Agents: Pharmacological Basis for their Antiarrhythmic and Proarrhythmic Effects: S. Sharma, T. Ho and B.K. Kantharia

Could Beta–Blocker Antiarrhythmic and Antiseizure Activity Help Prevent SUD EP?: C.M. Lathers

Decision Analysis and Risk Management: H.G. Claycamp

Epilepsy Surgery and the Prevention of SUDEP: R.S. Hays and M.R. Sperling

Challenges in Overcoming Ethical, Legal, and Communication Barriers in SUDEP: J. Hanna and R. Panelli

Bereavement and Sudden Unexpected Death in Epilepsy: L. Nashef and L. Sahlholdt

SUDEP: A Clinical and Communicative Conundrum: P.L. Schraeder and C.M. Lathers

Epilepsy and SUD EP: Lessons Learned: Scientific and Clinical Experience: C.M. Lathers and P.L. Schraeder

SUDEP: A Mystery Yet to Be Solved: C.M. Lathers and P.L. Schraeder

Forensic Evidence and Expert Witnesses: Scientific Evidence: Getting It In and Keeping It Out: T.L. Bohan


Subject Categories

BISAC Subject Codes/Headings:
LAW / Forensic Science
MEDICAL / Neurology