Anatomic Pathology: Forensic Pathology

• There is no pathognomonic finding at autopsy that allows the diagnosis of a fatal seizure to be made.

• To make this diagnosis, one must conduct a complete investigation and autopsy. The diagnosis of death resulting from a seizure is made when the medical history, scene investigation, and circumstances are consistent with it and there is no other reasonable cause at autopsy to account for the death.

• The typical scenario is of a person with a long-standing history of epilepsy who is found face down in bed.

• A complete autopsy is negative for disease, and the toxicology studies exclude drugs of abuse. The toxicology studies frequently show a subtherapeutic concentration of antiseizure medication.

• Bite marks of the tongue may be supportive of a fatal seizure, but not everyone who dies as a result of a seizure bites the tongue, and many people have “terminal” seizure activity with other causes of death that may result in bite marks of the tongue.

• Evidence of urinary or fecal incontinence may be present at the scene investigation or during autopsy.

• A complete neurologic examination is usually done, although these analyses cannot confirm a diagnosis of a fatal seizure.

• Even if a “seizure focus” is found or if there is extensive mesial temporal sclerosis, this does not prove that the person died of a seizure. It supports a seizure disorder, but the same findings would be present if the person had died as a result of a gunshot wound of the heart. In addition, a seizure focus is not always found even in patients with known epilepsy who are witnessed to die during a seizure.