Epilepsy is a neurological disorder caused by sudden excessive neuronal activity in the brain. Recurrent and unpredictable seizures are a hallmark of epilepsy, and these episodes can start at any age. Seizures can be caused by numerous factors, such as genetic defects in ion channel proteins, enzymes, G protein-coupled receptors (GPCRs) or gamma-aminobutyric acid (GABA) receptors. Other causes include traumatic brain injury, infections, strokes and brain tumours. The condition is considered to be one of the most common neurological disorders globally and is incurable, despite the presence of efficacious treatments that can reduce the frequency and intensity of seizures.
Sudden unexpected death in epilepsy (SUDEP) is a rare but fatal complication of epilepsy. SUDEP refers to a non-traumatic, non-drowning fatality that also has no toxicological or anatomical aetiology that can be identified upon post-mortem examination of the deceased. It is more common for an epilepsy-related death to result from a seizure that causes the patient to fall and injure themselves.
Unmodifiable risk factors for SUDEP include being asleep, mutations in genes that code for ion channel proteins, increased frequency of seizures, and male gender. However, effective pharmacotherapy for epilepsy can shorten the duration of seizures and allow refractory patients to attain a sense of control over their lives.
Drugs that have historically been used to treat epilepsy include phenytoin, carbamazepine, valproate and levetiracetam. The side effects of some of these agents, however, include hyponatraemia, diplopia and hypertrichosis. Despite these, drugs such as gabapentin, lamotrigine and topiramate have been shown to be well-tolerated by patients with focal seizures. As a result, these drugs are among some of the most frequently prescribed pharmaceutical agents in the US. With the development of comprehensive and regularly updated treatment guidelines published by the American Academy of Neurology and American Epilepsy Society, prescribing physicians have a greater understanding of the contraindications and pharmacokinetic profiles of specific anticonvulsants used to treat patients with epilepsy.
The individual characteristics of epileptic patients are increasingly being used to devise safe and tolerable treatment regimens to avoid the occurrence of SUDEP. It is, therefore, vital for high-risk patients to adhere to a treatment schedule that suits their way of life and effectively reduces the considerable impact of this frequently unpredictable neurological disorder.