Temporal lobe epilepsy and risk of sudden death

Abstract Introduction Mortality in epilepsy is 2–3 times higher than the general population. Sudden unexpected death of epileptic patients (SUDEP) is considered the main cause of death among patients with epilepsy. SUDEP is likely a cascade of events affecting autonomic and cardiorespiratory regulation. The anatomical localization of the cerebral autonomic structures within the temporal lobe makes it more liable for the SUDEP risk. Aim This narrative review aimed to shed light on the SUDEP risk in an attempt to understand its causes and identify preventive measures among patients with TLE. Methods This narrative review was conducted through a search on PubMed and Google Scholar from 1995 to 2023, using a combination of keywords to select relevant publications. Articles written only in the English language were included. Findings Dysautonomia was revealed among patients with epilepsy, which was further confirmed by structural imaging studies. Autonomic manifestations were specifically common among patients with temporal lobe epilepsy. SUDEP biomarkers are crucial for identifying patients at high risk of SUDEP. Different preventive methods can be employed, including pharmacological and surgical approaches. Conclusion The researchers are still paving the way toward unveiling the exact pathophysiology and identifying potential reliable SUDEP markers to facilitate SUDEP risk stratification and, thus, prevention.