[Sudden unexpected death in epilepsy: risk factors, prevention strategies, and approaches for family engagement].

Abstract

Sudden unexpected death in epilepsy (SUDEP) is an important cause of mortality in children with epilepsy, with a similar incidence to that of adults. Its epidemiology and pathophysiology are not yet fully defined. This review article addresses SUDEP in the pediatric population, describing its definition, epidemiology, pathophysiology and associated risk factors with a particular focus on prevention strategies and communication to families. Risk factors such as the presence and frequency of generalized tonic-clonic seizures -especially during sleep-, drug-resistant epilepsy, lack of nocturnal supervision and neurological comorbidities are emphasized. Proposed pathophysiological mechanisms include autonomic dysregulation, postictal respiratory depression and genetic susceptibility, particularly in developmental and epileptic encephalopathies such as Dravet syndrome. Preventive strategies are centered on seizure control, nocturnal monitoring, caregiver education and a multidisciplinary approach. Knowledge and education regarding the topic are often greater in specialized drug-resistant epilepsy centers, yet improvement is needed across all care settings. Informing families in a relevant and sensitive manner is highlighted, aiming to foster a trusting and supportive relationship. Although the risk of SUDEP cannot be completely eliminated, the implementation of evidence-based measures reduces its incidence.