What are the potential causes of death from a seizure?

From the Guidelines

Seizures can lead to death through several mechanisms, including SUDEP, status epilepticus, accidents, aspiration pneumonia, and underlying life-threatening conditions. The most common cause of death from a seizure is SUDEP (Sudden Unexpected Death in Epilepsy), which may occur due to cardiac arrhythmias, respiratory suppression, or neurogenic pulmonary edema during or after a seizure 1. Status epilepticus, a prolonged seizure lasting more than 5 minutes or multiple seizures without recovery between them, can cause brain damage or death if not treated promptly with medications like lorazepam, diazepam, or midazolam 1.

Some key points to consider:

• Accidents during seizures, such as drowning, falls, or vehicle crashes, are another significant cause of mortality.
• Aspiration pneumonia can occur when a person inhales food, fluid, or vomit during a seizure, potentially leading to fatal respiratory complications.
• Underlying conditions that trigger seizures, such as brain tumors, strokes, or infections, may themselves be life-threatening.
• People with epilepsy should take prescribed anticonvulsant medications consistently, avoid seizure triggers like sleep deprivation and alcohol, and ensure someone nearby knows seizure first aid, which includes placing the person on their side to prevent aspiration and avoiding putting anything in their mouth 1.

It's worth noting that the definition of status epilepticus has evolved over time, with some authors proposing a shorter time criteria for diagnosis, such as 5 minutes 1. However, the key takeaway is that prompt treatment is essential to prevent brain damage and death. According to the most recent guidelines, seizures lasting more than 5 minutes and multiple seizures occurring one after the other represent a critical medical emergency, status epilepticus 1.

From the FDA Drug Label

WARNING: LIFE THREATENING ADVERSE REACTIONS Hepatotoxicity General Population: Hepatic failure resulting in fatalities has occurred in patients receiving valproate and its derivatives. In patients with epilepsy, a loss of seizure control may also occur. Cases of life-threatening pancreatitis have been reported in both children and adults receiving valproate. Some of the cases have been described as hemorrhagic with a rapid progression from initial symptoms to death.

The potential causes of death from a seizure are not directly addressed in the provided drug label. However, the label mentions that loss of seizure control may occur in patients with epilepsy, which could potentially lead to fatal outcomes. Additionally, the label highlights the risk of hepatic failure and pancreatitis, which can be life-threatening.

• Hepatic failure resulting in fatalities has occurred in patients receiving valproate.
• Pancreatitis cases have been reported, some of which were described as hemorrhagic with rapid progression from initial symptoms to death. 2

From the Research

Potential Causes of Death from a Seizure

• Status epilepticus, a condition characterized by prolonged or repetitive seizures, can cause primary cerebral injury due to prolonged uncontrolled neuronal discharge or secondary cerebral injury due to hypoxia and hypothermia 3
• Acute complications of status epilepticus can result from hyperthermia, pulmonary edema, cardiac arrhythmias, and cardiovascular collapse, which can be life-threatening 4
• Neuronal injury leading to temporal lobe epilepsy is probably mediated by excess excitation via activation of the N-methyl-D-aspartate (NMDA) subtype of glutamate receptors and consequent elevated intracellular calcium that causes acute necrosis and delayed apoptotic cell death 4
• Mortality rates for status epilepticus are 15% to 20% in adults and 3% to 15% in children, with history of epilepsy being the strongest single risk factor for generalized convulsive status epilepticus 4

Risk Factors for Death from a Seizure

• History of epilepsy is the strongest single risk factor for generalized convulsive status epilepticus 4
• Young age, genetic predisposition, and acquired brain insults are also risk factors for status epilepticus 4
• Low antiepileptic drug levels are a potentially modifiable risk factor for status epilepticus 4
• Fever is a very common risk in children, as is stroke in adults 4

Treatment-Related Complications

• Early administration of benzodiazepines, such as lorazepam, for convulsive seizures may lead to systemic vital instability, including hypotension and respiratory depression 5
• Lorazepam administration can significantly prolong the intensive care unit (ICU) length of stay and increase the risk of vital instability 5
• The choice of benzodiazepine, such as lorazepam or diazepam, can affect the outcome of status epilepticus treatment, with lorazepam showing a significantly superior effect on seizure cessation compared to diazepam 6