OBJECTIVE: To evaluate risk factors for sudden and unexpected death in epilepsy 
(SUDEP) in a high-risk population, i.e. patients treated in a Dutch tertiary 
referral center for epilepsy.
METHODS: All patients who died between January 1999 and April 2004 while under 
treatment of the epilepsy center were identified. Based on clinical data, deaths 
were classified as definite, probable, possible or non-SUDEP. Potential risk 
factors were compared in SUDEP cases and non-SUDEP cases.
RESULTS: SUDEP incidence was 1.24 per 1000 patient years. SUDEP patients died at 
a younger age than patients from the control group of non-SUDEP deaths with 
epilepsy and had an earlier onset of epilepsy. However, the frequently mentioned 
factors in previous studies, i.e. male sex, generalized tonic-clonic seizures, 
high seizure frequency, specific AEDs, polytherapy with several AEDs, mental 
retardation, psychiatric illness and psychotropic comedication, were not found 
to be correlated with SUDEP.
CONCLUSIONS: Even in this high-risk population of patients with refractory 
epilepsy, treated in a tertiary referral center, SUDEP is not a frequently 
occurring phenomenon. Specific risk factors could not be identified within an 
already high-risk population.