Sudden unexpected death in epilepsy in a 14-year-old girl: case report and literature review

BACKGROUND: Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with epilepsy. The pathogenesis of SUDEP is still unclear. The majority of SUDEP cases occur in intractable epilepsy, especially in the aftermath of a generalized tonic-clonic seizure. We report an atypical SUDEP case with infrequent seizures in frontal lobe epilepsy. CASE REPORT: A 14-year-old girl presented with a 13-year history of paroxysmal convulsions. She experienced three episodes within 6–10 months after birth. At 14 years old, she experienced an aggravated seizure, manifesting as unconsciousness, hyperventilation, and urinary incontinence. Electroencephalography showed spike-slow waves and slow waves with mixed asynchronized spike waves originating from the frontal lobe during the sleep stage. Transient outbreaks of spike-slow complex waves (1–2 s) were also noted in all leads. The diagnosis of frontal lobe epilepsy (generalized tonic-clonic seizures secondary to focal impaired awareness seizures and myoclonus) was made. Oral sodium valproate was prescribed. However, she suddenly died on her way to school 2 months later. CONCLUSION: The causes of SUDEP are complicated, and frontal lobe epilepsy may be a potential risk factor. Early diagnosis and appropriate treatment of epileptic seizures, as well as close observation, should be emphasized.