Forensic antiepileptic drug levels in autopsy cases of epilepsy

► This 1-year forensic retrospective study reviewed death certificates/coroner autopsies of victims of sudden unexpected death in epilepsy. ► Among 12 of 1200 persons with a history of epilepsy and/or seizures, 11 deaths were determined to be caused by SUDEP and 1 by a glial tumor. ► Of the 7 men, 5 were classified as definite SUDEP and 2 as possible SUDEP; of the 5 women, 2 were definite SUDEP, 2 possible SUDEP, 1 non-SUDEP. ► Blood, bile, urine, and eye fluid were analyzed in all 12 deaths; 7 had detectable and 5 had no detectable antiepileptic drug levels. ► Among the 7 for whom levels were detectable, 4 had subtherapeutic, 2 had therapeutic, and 1 had above therapeutic levels.