Nocturnal monitoring in epilepsy

Should patients with epilepsy be monitored during sleep to prevent sudden unexpected death in epilepsy (SUDEP)? The study by van der Lende et al.1 provides additional evidence that the answer is probably yes in certain populations. These investigators compared the incidence of SUDEP at 2 residential centers for adults with severe epilepsy (>90% had convulsive seizures, and ∼50% were on ≥3 antiepileptic drugs). The center with less intensive nocturnal monitoring had a nearly 3-fold higher SUDEP incidence that was not explained by other factors (e.g., seizure severity). Sadly, despite monitoring, supervision, and expert care at both centers, the SUDEP rate remained 2- to 5-fold greater than population-based studies of patients with epilepsy. Unlike some other case-control studies, the incidence of SUDEP was higher among individuals with higher IQ and less benzodiazepine use.