Sudden unexplained death in epilepsy : An intracranially monitored case

A 47-year-old man with intractable complex partial seizures experienced sudden unexpected death during intracranial electroencephalography (EEG) recording and video monitoring as part of presurgical assessment. The patient died 7 days after implantation of intracranial electrodes. Antiepileptic drugs had been withdrawn. The fatal seizure started in the right mesial temporal structures and became generalized. After 2.5 min the EEG showed brief complete flattening, alternating with spindling spike discharges, before activity ceased. These events occurred first in the right and then in the left hemisphere. A regular pulse artifact was noted for a further 120 Postmortem examination revealed bi-occipital ulegyria. It is suggested that the primary cause of death was cerebral in origin rather than cardiogenic.