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recurance

Andrew Ewin-Ripp

2 Apr 2024 · Coroner Nadia Persaud · East London

This report repeats 1 earlier warning. See the linked reports.

The coroner's concerns

  1. 1. SUDEP deaths in young adults

    “There are believed to be around 500-600 SUDEP deaths in the UK each year. SUDEP deaths are common in young adults. The waiting times for outpatient neurology appointments is in the region of 9 months for the trust concerned. The inquest heard from an independent expert that it is not unusual to have waiting times of more than 6 months for outpatient neurology appointments. In the context of these lengthy waiting times, the following matters were of particular concern:”
  2. 2. lack of annual epilepsy patient reviews

    “GP practices are not required to carry out annual reviews of epilepsy patients, as they are, for other chronic diseases. The independent consultant neurologist considered that annual reviews by general practitioners would provide an excellent safety net to prevent future SUDEP deaths. The reviews could incorporate checks on compliance with medication; reviews of any seizure activity and reminder of ways to reduce the risk of seizures.”
  3. 3. absence of clear guidance on long-term epilepsy monitoring

    “There is clear national guidance in relation to how quickly patients should be seen following a first seizure, but no clear guidance around the longer-term monitoring of patients with epilepsy. How soon after the last seizure is it safe to discharge a patient? There is no clear guidance on this.”

Linked reports

Repeats an earlier warningNicholas Pennicott11 May 2023 · 11 months earlier
Closely relatedConfidence 0.90 · high

Earlier report

“long waiting times for neurology outpatient appointments was a persistent challenge for the Trust due to capacity issues within the neurology service.”
Original on judiciary.uk ↗

This report

“The waiting times for outpatient neurology appointments is in the region of 9 months for the trust concerned.”
Full chain: Delayed neurology outpatient appointments increase SUDEP risk

Responses

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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error