SUDEP Incidence – Drug-Resistant Epilepsy — SCE Neurology MCQ

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ModerateEpilepsy & Seizure DisordersSUDEP Incidence – Drug-Resistant EpilepsySCE Neurology

A 45-year-old man with epilepsy controlled on levetiracetam has a seizure while swimming alone and drowns. The coroner classifies this as SUDEP. What is the approximate annual incidence of SUDEP in patients with drug-resistant epilepsy?

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Correct answer: D — 1 in 150 per year (approximately 0.7%)

The incidence of SUDEP varies by population: in the general epilepsy population it is approximately 1 in 1,000 per year, but in drug-resistant epilepsy it is significantly higher — approximately 1 in 150 per year (0.7%). Risk factors include uncontrolled GTCS (especially nocturnal), polytherapy, young adult age, and poor medication adherence. NICE NG217 recommends discussing SUDEP risk with all epilepsy patients. Optimal seizure control is the most important preventive measure. A: This is lower than the drug-resistant rate. B: This is the general epilepsy population rate. D: Much too high. E: Much too low.

Reference: NICE NG217 (2025); Harden et al. AAN SUDEP Guideline (2017)