The recent concept of sudden unexplained death in epilepsy (SUDEP) has made clinicians more aware of epilepsy related deaths. With the publication of the National Sentinel Clinical Audit of Epilepsy Related Death, the general public and the media became concerned at this apparently new phenomenon.¹ The impact of this audit was such that the chief medical officer, Sir Liam Donaldson, vowed “to develop an action plan to reduce the level of preventable deaths from epilepsy within three months of publication of this report”.²The Independent newspaper lamented the fact that “inadequate care by the NHS causes up to 500 deaths a year”.³The Guardian health correspondent, in an article with the headline “NHS failings blamed for deaths among epileptics”, interpreted the report as saying that “about 400 people with epilepsy are dying each year because of failures in diagnosis, treatment and monitoring of the disease within the NHS”.⁴ An editorial in The Lancet, timed to coincide with publication of the audit, concluded that “poor epilepsy management results in a substantial number of potentially avoidable deaths”.⁵

Although the increased interest in patients with epilepsy is welcome, the excited media reaction to the report, at least where it concerns children, is misleading. It should be remembered that the audit was limited by small numbers and incomplete information. Of 81 deaths that occurred in children under the age of 18 years between September 1999 and August 2002 where epilepsy was judged to be the probable cause of death from examination of the death certificate, quality of general practice and hospital based care was investigated in only 22. It is foolhardy to make general statements about the care of children based on such small numbers and the report itself acknowledges that “an audit of epilepsy …