Recent studies indicate that the overall mortality rate for persons with epilepsy is elevated two- or threefold compared with the general population. The standardized mortality ratio (SMR) is greatest in the first few years after diagnosis and in symptomatic epilepsies. Idiopathic epilepsies also have a small increase in SMR. The sudden unexpected death rate in those with epilepsy (SUDEP) depends on the population examined. In the general population of persons with epilepsy, the risk is between 1:500 and 1:1,000 person-years. For those with severe epilepsy or other neurologic impairments, the risk appears to be 1:200 person-years. The risk in children remains uncertain. Estimates of mortality should be borne in mind when patients are counseled about the risks and benefits of various treatment strategies.