The new guideline by the American Academy of Neurology (AAN) and the American Epilepsy Society (AES) on sudden unexpected death in epilepsy (SUDEP) is a landmark.  The communication between medical professionals and patients about SUDEP risk remains unacceptably low. Tragically, family members often first learn about SUDEP after their loved one’s death. Every patient and parent deserves to know the risks of epilepsy. For the first time, the AAN and AES recommend that neurologists inform them about SUDEP, the most common cause of epilepsy-related death. 
Generalized tonic-clonic seizures increase SUDEP risk; the greater their frequency, the greater the risk. [2,3] Minimizing seizures through specialized medical care and strategies to reduce breakthrough seizures can reduce risk. [2,3] Since SUDEP happens more often in sleep,  nighttime supervision or monitoring may help and should be part of the patient/provider conversation. While the report assigns a blanket SUDEP risk ratio to children,  certain pediatric populations (children with Dravet syndrome, Dup15q syndrome, etc.) face a significantly higher risk. [4,5]
All medical professionals should use these recommendations to initiate an honest and ongoing conversation tailored to their patient’s risk. We urgently need accurate surveillance data and expanded research to understand the mechanisms and save lives.
1. Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2017;88:1674-1680.
2. Devinsky O, Hesdorffer DC, Thurman DJ, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol 2016;15:1075-1088.
3. Tomson T, Surges R, Delamont R, Haywood S, Hesdorffer DC. Who to target in sudden unexpected death in epilepsy prevention and how? Risk factors, bi