Difficultly Distinguishing Drowning-Related Deaths From SUDEP

Person in Bath
Person in Bath
Researchers examined a database of seizure-related deaths to determine whether cause was drowning or sudden unexpected death in epilepsy.

In people with epilepsy, sudden unexpected death in epilepsy (SUDEP) and drowning are the most common causes of mortality, according to a study published in Epilepsia. These deaths are often unobserved and difficult to study in autopsy, particularly when no drowning-related signs or indications of submersion are noticeable.

A database of patients with seizure-related deaths who underwent medicolegal investigation between 2000 and 2016 was used to identify persons with epilepsy-related drownings and SUDEPs. Patients with epilepsy-related drownings were categorized as belonging to 2 groups, including definite drowning (n=36), defined as a patient who was witness as being submerged in water or being found with the mouth and nose covered in water, and possible drowning (n=11), which was defined as a patient who was partially submerged in water and of whom no parts of the face and airway were immersed in water. In addition, the SUDEP group was categorized into definite SUDEP (n=92) and definite SUDEP plus cases.

Of the drowning epilepsy cases, the majority of drownings were recorded as occurring in the bathtub (72.3%). In addition, 88.9% cases of definite drowning and 83.7% cases of SUDEP were unwitnessed. Fluid was often found in the sphenoid sinuses and stomach, and foam in the airways and lung hyperinflation were also observed in 58.3%, 45.5%, and 4.3% of definite drownings, possible drownings, and the SUDEP groups, respectively.

There were no differences among the definite drowning, possible drowning, or SUDEP groups with regard to pulmonary edema/congestion (61.1%, 63.6%, and 51.1%, respectively; χ2=1.44; P =.49).

Although decedents in the definite drowning group presented with a higher average combined lung weight compared with decedents in the SUDEP group (P =.02), no differences were found with regard to the mean lung weights among persons in the possible drowning (P =.74) and SUDEP (P =.61) categories.

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A limitation of the analysis included the small number of patients in the possible drowning group, which the researchers suggested reduced the sensitivity of the findings.

The results of this study indicated the importance of discussing bathtub safety “with patients and caregivers at the time of epilepsy diagnosis and reemphasized at follow-up visits.”


Cihan E, Hesdorffer DC, Brandsoy M, et al. Dead in the water: Epilepsy-related drowning or sudden unexpected death in epilepsy? Epilepsia. 2018;59(10):1966-1972.