Remarks y SUDEP is defined as sudden, unexpected, witnessed or unwitnessed, non-traumatic or non-drowning death of people with epilepsy, with or without evidence of a seizure, excluding documented status epilepticus and in whom postmortem examination does not reveal a structural or toxicological cause for death. y This intervention is considered especially appropriate for those who have convulsive seizures from sleep. y Nocturnal supervision was defined by Langan et al. (2005) as “the presence of an individual of normal intelligence and at least 10 years old in the bedroom” (189). The use of special precautions is also considered as a part of nocturnal supervision in this recommendation. Special precautions involved regular checks throughout the night or the use of a listening device. y There are limited anticipated risks of nocturnal supervision and this intervention is expected to be of low cost.

Implementation considerations y Some training is required for the person performing checks, but this is anticipated to be minimal. y All reasonable measures to reduce the risks of having seizures and to mitigate the risks from seizures should be initiated. y People with epilepsy should be encouraged to adhere to their ASMs, to avoid sleep deprivation, to avoid excess alcohol consumption and to not take recreational substances. These measures will reduce the risk of having a seizure and thereby reduce the risk of seizure-associated mortality. y People with epilepsy should also be informed to exercise due caution so that, were they to have a seizure, the chance of injury to themselves or others is minimized. People with epilepsy should not, for example, have baths, but shower or take strip-washes instead. People with epilepsy, especially those with seizures arising from sleep, should avoid sleeping prone to reduce the risk from sleep seizures. y Physicians should identify comorbid mental health conditions and, if present, implement early effective interventions as they contribute to increased seizure risk and attendant risks, including SUDEP.