China
Africa
Explore chapters and articles related to this topic
Sudden unexpected death in epilepsy
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Christopher Milroy, Daniel du Plessis
Cardiac rhythm changes are increasingly recognised (Devinsky et al. 2016). The principal arrhythmia identified is bradycardia. While pre-ictal tachycardia has been observed, the evidence for malignant tachydysrhythmia as the terminal event is limited (Sevcencu and Struijk 2010). An analysis of patients with intractable epilepsy for a total of 220,000 patient hours with outpatient cardiac monitoring reported that 21 per cent had at least one bradycardic seizure (Rugg-Gunn et al. 2004). Most patients with ictal bradycardia or asystole had temporal lobe epilepsy but it may also be seen in frontal lobe epilepsy.
Prevention of sudden unexpected death in epilepsy: current status and future perspectives
Published in Expert Review of Neurotherapeutics, 2020
Max Christian Pensel, Robert Daniel Nass, Erik Taubøll, Dag Aurlien, Rainer Surges
The majority of monitored SUDEP cases result from a primary postictal apnea followed by bradycardia and asystole within minutes after seizure termination [24]. In line with this finding, potentially arrhythmogenic ECG changes were observed in a minority of seizures only during conventional EMU recordings [61–64]. However, in about 0.4% of patients during video-EEG monitoring, ictal bradycardia and asystole occur, which was in all cases self-limiting and most probably due to activation of vasovagal reflex pathways or impaired balance between sympathetic and parasympathetic branches of the autonomic nervous system [65]. Since ictal bradyarrhythmias may lead to syncopes and falls, a treatment with cardiac pacer devices is recommended in these cases if full seizure control cannot be achieved [65–67]. A small and maybe underestimated portion of SUDEP cases is caused by peri-ictal ventricular arrhythmias, some in the context of a Takotsubo cardiomyopathy, as described in a number of case reports [68–73]. Ventricular tachycardias, in turn, are facilitated by abnormalities of cardiac repolarization (e.g. prolonged QT intervals, increased QT dispersion, increased T wave alternans) which are commonly found in people with chronic epilepsy [74,75]. Valid ECG predictors for an increased SUDEP risk, however, were not convincingly reported to date [63,76].