title: Impact of antiseizure medication level on the incidence of sudden unexplained death from epilepsy in patients from an inner city emergency department.
abstract: Sudden unexplained death from seizures (SUDS) accounts for death in approximately 10% of the epileptic population. SUDS usually occurs in young males with a history of seizure disorders who are in otherwise good health. No definitive anatomical lesions are found at autopsy that explain death. There is however, a correlation between SUDS and subtherapeutic levels of antiseizure medications. The purpose of this study was to retrospectively review and compare drug levels from a seizure patient that presented to an inner city emergency department to those from the medical examiners office. This study was prompted by a wrongful death claim for substandard care in a known seizure disorder patient. The claim alleged that the death was directly attributed to subtherapeutic seizure medication levels. We report the results from 150 seizure patients that presented to the emergency department with a chief complaint of a recent seizure and of 163 patients that were examined post mortem. 58% of the emergency department patients who were taking phenytoin, 79% taking carbamazapine and 82% of the patients taking phenobarbital had subtherapeutic levels. No patient in this population died and only 13% required hospital admission. These levels were comparable to the post mortem population.
authors.affiliation: Department of Emergency Medicine and Clinical Toxicology, University of Tennessee Medical Group, PO Box 63637 Memphis, TN 38163, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Merigian
authors.forename: K E
authors.initials: KE
authors.lastname: Blaho
authors.forename: H S
authors.initials: HS
authors.lastname: Nichols