45-year-old woman with chronic epilepsy and intellectual disability died following a prolonged seizure with cardiac arrest at a supported accommodation facility. She was found fitting, became unresponsive and apnoeic with asystolic arrest. Despite effective CPR and intensive care management including intubation and anti-seizure medication loading, she had severe hypoxic brain injury and limited neurological recovery. Blood levels of sodium valproate and phenytoin were subtherapeutic on admission. The Clinical Liaison Service found no identifiable association between cause of death and healthcare management. Key lesson: patients with recurrent seizures despite multiple anti-seizure medications require careful medication level monitoring and optimisation to prevent breakthrough seizures and potential SUDEP.
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