It has been suggested that alerting caregivers to seizure occurrence so they can deliver post-ictal care may be an effective way to prevent sudden unexpected death in epilepsy (SUDEP). We report two cases of SUDEP referred for an expert medical-legal review for which immediate post-ictal intervention was ineffective. In both patients, prompt resuscitation procedures by medical personnel after seizures failed to prevent SUDEP. These cases demonstrate that some seizures may lead to death even with expert intervention almost immediately after the seizure occurs. It is possible that for some SUDEP cases, seizures may trigger an irreversible cascade of cardiopulmonary and cerebral changes that lead to death. Further studies in the pathophysiology of SUDEP may help identify alternative prevention strategies.
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