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A Nationwide Survey of the Extent of Autopsy in Sudden Unexplained Death in Epilepsy

Schraeder, Paul L. MD*; Delin, Kristen MS; McClelland, Robyn L. PhD; So, Elson L. MD§

The American Journal of Forensic Medicine and Pathology: June 2009 - Volume 30 - Issue 2 - p 123-126
doi: 10.1097/PAF.0b013e318187a266
Original Article

Sudden unexplained death in epilepsy is a catastrophic event that requires autopsy for definitive diagnosis. Lack of awareness of sudden unexplained death in epilepsy as an important cause of death in epilepsy has been observed among coroners and pathologists. This survey study of US coroners and medical examiners (MEs) assesses their postmortem examinations of persons with epilepsy who had died suddenly without obvious cause. Analysis of the 510 survey responses shows that pathologists are significantly more likely than nonpathologists to inquire routinely about a history of cardiac disease, remove the brain for examination, or collect blood samples for determinations of anticonvulsant and psychotropic drugs. Urban coroners and MEs are significantly more likely than their nonurban colleagues to remove the brain for examination or collect blood samples for these determinations. Lack of family consent and the cost of autopsy are major reasons for not performing an autopsy of persons with epilepsy. Our study underscores the importance of promoting to all coroners and MEs and to the public the need for thorough autopsy of persons with epilepsy when the cause of death is not obvious.

From the *Department of Neurology, Drexel University College of Medicine, Philadelphia, PA; †Department of Nursing, Thomas Jefferson University, Philadelphia, PA; and ‡Division of Biomedical Informatics and Biostatistics and §Department of Neurology, Mayo Clinic, Rochester, MN.

Manuscript received June 13, 2007; accepted July 1, 2007.

Supported by Albert Einstein Foundation of Philadelphia and Mayo Foundation for Medical Education and Research.

Robyn L. McClelland, PhD, is currently at the Department of Biostatistics, University of Washington, Seattle, WA.

Reprints: Elson L. So, MD, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail: eso@mayo.edu.

© 2009 Lippincott Williams & Wilkins, Inc.