We read with interest the article by Natelson et al1 but we believe, however, that there are a number of points that need to be raised with respect to other possible mechanisms for sudden unexpected death in epilepsy (SUDEP). While the authors mention that seizures have been associated with cardiac arrhythmias, they do not allude to the fact that apnea, mainly central in nature, has been noted in association with both generalized and partial seizures.2
Langan Y, Sander JWAS. Patients With Epilepsy Who Die Suddenly Do Not Always Have Cardiac Disease. Arch Neurol. 1999;56(2):249. doi:10.1001/archneur.56.2.249
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