Sudden Unexpected Death In Epilepsy

Cardiac arrhythmias are a potential cause of sudden unexpected death in epilepsy (SUDEP), claiming as many as 500 patients in the UK each year. It appears that patients with epilepsy may be predisposed to developing arrhythmias due to a number of factors including, chronic autonomic dysfunction, effects of anti-epileptic medication and a common genetic susceptibility.

These are among the findings in a major review, epilepsy and the heart,¹ in the British Journal of Cardiology. Written by Drs Fergus Rugg-Gunn and Di Holdright from The National Hospital for Neurology and Neurosurgery, London.

“Although most cardiac sequelae of seizures are benign, transient and self-limiting, the heart may play a crucial role in the aetiological basis of SUDEP” say the authors.

The identification of patients at risk of ictal (seizure) cardiac arrhythmias and possibly SUDEP, is an important goal, as pacemaker insertion may be preventative. “A key aim (therefore) is to is to stratify the risk of  SUDEP for an individual patient and, ideally, identify potential therapeutic targets” the authors suggest.

In the same BJC issue, Dr Elijah Chaila and colleagues at Beaumont Hospital, Dublin’s, Epilepsy Programme, describe five cases ² of ictal bradycardia and asystole associated with intractable epilepsy. They discuss the potential role of implantable loop recorders in the evaluation of patients with epilepsy who clinically appear to be at increased risk for ictal asystole.

References

1. Rugg-Gunn FJ, Holdright D. Epilepsy and the heart. Br J Cardiol 2010;17:223-9.
2. Chaila E et al. Ictal bradycardia and asystole associated with intractable epilepsy:a case series. Br J Cardiol 2010;17:245-8.