Maternal mortality has long been associated with a handful of well-known causes, but sudden unexpected death in epilepsy has not typically been one of them. We describe a 16-year-old at 21 weeks gestational age whose sudden unexpected death was precipitated by her pre-existing seizure disorder potentially complicated by pre-eclampsia diagnosed by post-mortem evidence. Physiologic changes in pregnancy cause not only hemodynamic burden for mother but also changes in normal metabolism. The use of antiepileptic drugs in pregnancy has been a matter of concern for teratogenicity and decreased serum levels due to metabolic changes. These changes have the potential for breakthrough seizures in pregnancy, leading to death. More effective patient monitoring and education for pregnant patients with pre-existing epilepsy is needed, as is awareness for increased risk of preeclampsia and screening of pre-eclampsia in these patients.

Authors: Kimberly Collins, Joseph A. Prahlow

Key Words: SUDEP, sudden death, epilepsy, seizure, antiepileptic, pregnancy, pre-eclampsia