DOI: https://doi.org/10.14710/dmj.v15i1.53109

MEDICOLEGAL AND ETHICAL ASPECTS OF A DEATH CASE DUE TO EPILEPSY: CLINICAL CASE, CLINICAL FORENSICS, OR FORENSIC PATHOLOGY?

*Adji Suwandono orcid scopus publons  -  Department of Forensics and Medicolegal, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia , Indonesia
Hedva Rayna Hitipeuw  -  Medical Profession, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia, Indonesia
Funica Asri Rachmawaty  -  Medical Profession, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia, Indonesia
Sandy Adi Nugraha Pratama  -  Medical Profession, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia, Indonesia
Alfonsus Aryo Sunu Bakti  -  Medical Profession, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia, Indonesia
Open Access Copyright 2025 Adji Suwandono
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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Abstract

Background: An unwitnessed death in a man with epilepsy, found in a bathroom with a head injury and immersion, raises key clinical and forensic concerns. This case highlights the complex intersection between epilepsy-related death, head trauma, and possible drowning. Case Presentation: A 39-year-old man with a history of epilepsy was found unconscious in the bathtub, face down with his head submerged and a bleeding forehead wound, approximately 10 minutes after showering. The man had a history of monthly generalized tonic-clonic seizures with recurrent falls and head injuries, and was on regular antiepileptic medicine. On admission, he was unresponsive with a GCS of E1V1M1, absent vital signs, dilated pupils, decreased skin temperature, and a laceration wound on the forehead. An ECG showed asystole. Conclusion: This case reviews the high risk of sudden death in patients with epilepsy, likely involving seizure-induced trauma and possible drowning. It emphasizes the need for comprehensive epilepsy management and thorough medicolegal evaluation to determine the cause of death.

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Keywords: epilepsy, epilepsy-related death, sudden unexpected death in epilepsy, head trauma, drowning, asphyxia
Funding: Hedva Rayna Hitipeuw, Funica Asri Rachmawaty, Sandy Adi Nugraha Pratama, Alfonsus Aryo Sunu Bakti

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Section: Case Report
Language : EN
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  2. Zhang, X., Zhang, J., Wang, J., Zou, D., Li, Z. Analysis of forensic autopsy cases associated with epilepsy: Comparison between sudden unexpected death in epilepsy (SUDEP) and not-SUDEP groups. Frontiers in neurology, 2022; 13:1077624
  3. Sirbu, C.A., Sirbu, O.M., Sandu, A.M., Plesa, F.C., Ioan, B.G. Ethical considerations in sudden unexpected death in epilepsy (SUDEP). Romanian Journal of Military Medicine, 2017; 120 (2)
  4. NICE. Epilepsies in children, young people and adults. London: NICE; 2022. NG217
  5. So, E.L., Bainbridge, J., Buchhalter, J.R., Donalty, J., Donner, E.J., Finucane, A., Graves, N.M., Hirsch, L.J., Montouris, G.D., Temkin, N.R., Wiebe, S., Sierzant, T.L. Report of the American Epilepsy Society and the Epilepsy Foundation joint task force on sudden unexplained death in epilepsy. Epilepsia, 2009; 50 (4):917-22
  6. Whitney, R., Jones, K.C., Sharma, S., RamachandanNair, R. SUDEP counseling: Where do we stand? Epilepsia, 2023; 64:1424-1431
  7. Watkins, L., Henning, O., Bassett, P., Ashby, S., Tromans, S., Shankar, R. Epilepsy professionals' views on sudden unexpected death in epilepsy counselling: A tale of two countries. European Journal of Neurology, 2024; 31: e16375
  8. Beran, R.G. SUDEP revisited – A decade on: Have circumstances changed? Seizure, 2015; 27:47-50
  9. Beran, R.G., Devereaux, J.A., Buchanan, D. Some legal aspects of epilepsy. Epilepsy & Behavior, 2020; 111:107244
  10. Atherton, D.S., Ddevinskiy, O., Hesdorffer, D.C., Wright, C., Davis, G.G. Implications of Death Certification on Sudden Unexpected Death in Epilepsy (SUDEP) Research. Academic Forensic Pathology, 2016; 6(1):96-102
  11. Middleton, O., Atherton, D., Bundock, E., Donner, E., Friedman, D., Hesdorffer, D., Jarrell, H., McCrillis, A., Mena, O.J., Morey, M., Thurman, D., Tian, N., Tomson, T., Tseng, Z., White., S., Wright, C., Devinsky, O. National Association of Medical Examiners position paper: Recommendations for the investigation and certification of deaths in people with epilepsy. Epilepsia, 2018; 59(3):1-14
  12. Ginsburg, J., Smith, T. Traumatic Brain Injury. Treasure Island (FL): StatPearls Publishing; 2025
  13. Blennow, K., Brody, D. L., Kochanek, P. M., Levin, H., McKee, A., Ribbers, G. M., Yaffe, K., Zetterberg, H. Traumatic brain injuries. Nature Reviews Disease Primers, 2016; 2
  14. Refaat, R.M.M., Haroun, M.R., Sharf El Din, A.A.E.W., Hussein, A.Y., Elkader, A.A.E.A. Medico Legal Aspects of Traumatic Head Injuries in Benha University Hospital. The Egyptian Journal of Forensic Sciences and Applied Toxicology, 2019; 19(4):119–45
  15. Sacco, M. A., & Aquila, I. Post Mortem Molecular Biomarkers of Asphyxia: A Literature Review. International Journal of Molecular Sciences, 2024; 25(21)
  16. Gupta, S. K. Forensic Pathology of Asphyxial Deaths. CRC Press; 2022
  17. DiMaio, V. J., & DiMaio, D. Forensic Pathology (2nd ed.). CRC Press; 2001
  18. Shetty, V.V. Medicolegal Aspects of Asphyxia with Reference to Hanging. Journal of Evidence Based Medicine and Healthcare, 2014; 1(11):1463–70
  19. Hădăreanu, V., Eliza, D.R. Medico-legal and Social Aspects of Mechanic Asphyxias. Acta Marisiensis - Seria Medica, 2015; 57(2)
  20. Jiju, V.S., Mappalakayil, T., Sasikala, K.S. Medicolegal Aspects of Microscopic Finding in Drowning. International Journal of Pharmaceutical and Clinical Research, 2022; 421-430
  21. Friedman, D.E., Chiang, S., Tobias, R.S. Do Recurrent Seizure-Related Head Injuries Affect Seizures in People with Epilepsy? Epilepsy Behav, 2012; 23:159–161
  22. Rao, S., Stino, A., Seraji-Bozorgzad, N., Shah, A.K., Basha, M.M. Seizure-Related Injury and Postictal Aggression in Refractory Epilepsy Patients. Epilepsy Res, 2020: 160:106281
  23. Englander, J., Bushnik, T., Wright, J. M., Jamison, L., Duong, T. T. Mortality in late post-traumatic seizures. Journal of Neurotrauma, 2009; 26(9):1471–1477
  24. Terra, V. C., Cysneiros, R., Cavalheiro, E. A., Scorza, F. A. Sudden unexpected death in epilepsy: from the lab to the clinic setting. Epilepsy Behav, 2013; 26:415–420
  25. Jiang, R.Y., Varughese, R.T., Kothare, S.V. Sudden Unexpected Death in Epilepsy: A Narrative Review of Mechanism, Risks, and Prevention. Journal of Clinical Medicine. 2025; 14(10):3329

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