In the Quest for Answers: Exploring Circumstances Around Pediatric SUDEP

Circumstances Surrounding Sudden Unexpected Death in Epilepsy in Children: A National Case Series. Whitney R, Keller A, Li SA, Datta AN, MacDonald M, Nabavi Nouri M, Pohl D, Sell E, Ronen GM, Sidhu M, Simard-Tremblay E, Pollanen MS, Donner EJ. Epilepsia . 2025 Jun;66(6):1988-2000. doi: 10.1111/epi.18339. Epub 2025 Apr 5. PMID: 40186506. Objective: This study was undertaken to understand the circumstances surrounding pediatric sudden unexpected death in epilepsy (SUDEP) and identify clinical factors that may be associated with SUDEP in childhood. Methods: A retrospective case series was conducted. Pediatric SUDEP cases were collected across Canada from the Ontario Forensic Pathology Service, Canadian Pediatric Surveillance Program, and Canadian Pediatric Epilepsy Network. Demographics, epilepsy history, comorbidities, and circumstances surrounding death were analyzed. Results: Forty-nine children with pediatric SUDEP were analyzed; 25 (51%) were females, and the median age at death was 8 years. Six children (12%) were <2 years of age at the time of death. Information on seizure types 6 months before death was known in 35 children. Twenty-two had tonic–clonic seizures within the last 6 months prior to death (63%). Seven children (18%) had no tonic–clonic seizures in their lifetime. Two thirds of children were treated with ≥2 antiseizure medications. Genetic etiologies were most common (55%). Data on global developmental delay (GDD) was known in 46 children: 12 children (26%) had no impairment, and 34 were globally delayed (74%). Children with GDD had earlier age at seizure onset ( P < .001); however, epilepsy duration was similar to those without GDD ( P = .170). Similar to adult cohorts, death was often unwitnessed (n = 41/46, 89%). Information on recent infection before death was known in 37 children. Seventeen children (46%) had a recent infection. Significance: Our study represents the largest pediatric SUDEP case series to date. SUDEP occurred in children of all ages, including infants, with a spectrum of epilepsies with and without neurodevelopmental impairment. The circumstances around death (ie, timing of death, witnessed/unwitnessed) were similar to previous SUDEP cohorts. A recent infection was often observed, which could decrease seizure threshold and trigger a terminal seizure and may suggest that times of increased seizure risk could warrant heightened surveillance for SUDEP. However, further research is needed to determine the significance of this finding.