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Arch Neurol. 1999;56:249.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with interest the article by Natelson et al¹ but we believe, however, that there are a number of points that need to be raised with respect to other possible mechanisms for sudden unexpected death in epilepsy (SUDEP). While the authors mention that seizures have been associated with cardiac arrhythmias, they do not allude to the fact that apnea, mainly central in nature, has been noted in association with both generalized and partial seizures.²

Obstructive apnea also occurred in the same study, but its extent was probably underestimated given the controlled environment in which this study was carried out.

Bradyarrhythymias, often transient, have been noted in association with apnea where they may occur as a result of the ictal discharge or as a response to the apnea mediated by the cardiorespiratory reflex. In a study of SUDEP³ in a pediatric residential setting where children were carefully supervised at night . . . [Full Text of this Article]