Re: Cardiac> Sudden, Unexplained Death in Epilepsy

[Guest guest]

I lost a dear friend from suffocation about seven years ago. She had

just had brain surgery and about a month after suffocated herself from

a grand mal in bed. Now if that was the reason, no one ever knew.

Sad but it happens.

That is when my family and I opened our eyes to epilepsy and never

took it lightly again. EVERYTHING HAPPENS FOR A REASON.

> http://www.medscape.com/viewarticle/496150?src=mp

>

> Cardiac Dysrhythmias May Be an Important Cause of Sudden,

Unexplained Death

> in Epilepsy

>

> Laurie Barclay, MD

>

>

> Dec. 17, 2004 †" Cardiac dysrhythmias may be important as a cause

of sudden,

> unexplained death in epilepsy, according to the results of a

prospective,

> long-term study published in the Dec. 18/25 issue of The Lancet.

>

> " We have shown that implantable loop recorders can identify

potentially fatal

> cardiac abnormalities in patients with epilepsy, and suggest that the

> incidence of bradycardia and asystole has previously been

under-reported, " senior

> author S. Duncan, from the National Hospital for Neurology and

Neurosurgery

> in London, U.K., says in a news release. " Asystole underlies a

proportion of

> sudden unexpected deaths in epilepsy, which could be prevented by

> cardiac-pacemaker insertion. "

>

> At one hospital in the U.K., 20 patients with refractory focal seizures

> received an implantable loop recorder programmed to record

automatically in the

> presence of bradycardia (<40 beats per minutes) or tachycardia (>140

beats per

> minute). If a seizure developed, patients and relatives could also

begin ECG

> recording with an external activator device. Implantable loop

recorder data were

> analyzed regularly and correlated with seizure diaries.

>

> During more than 220,000 patient-hours monitored over 24 months,

ECGs were

> captured on implantable loop recorders in 377 seizures. One patient

withdrew

> from the study. In 16 patients, median heart rate during habitual

seizures was

> greater than 100 beats per minute. Ictal bradycardia (less than 40

beats per

> minute) occurred in only eight recorded events (2.1%) in seven

patients. Of four

> patients (21%) with bradycardia or periods of asystole who

subsequently had

> permanent pacemaker insertion, three patients (16%) had potentially

fatal

> asystole.

>

> " Clinical characteristics of patients with peri-ictal cardiac

abnormalities

> are closely similar to those at greatest risk of sudden unexpected

death in

> epilepsy, " the authors write. " Asystole might underlie many of these

deaths,

> which would have important implications for the investigation of

similar patients

> and affect present cardiac-pacing policies. "

>

> Study limitations include small sample size.

>

> The authors report no conflict of interest. Medtronic supported this

study

> and supplied the Reveal Plus devices. The Research and Development

Directorate

> of University College London Hospitals NHS Trust provided financial

support.

>

> In an accompanying commentary, Lawrence J. Hirsch and W.

Hauser, from

> Columbia University in New York, N.Y., call for larger confirmatory

studies

> before considering changes in clinical practice.

>

> " The study provides the first real hope that some cases of sudden

unexplained

> death in epilepsy (SUDEP) might be preventable, " they write. " Although

> non-cardiac causes remain difficult to prevent, permanent pacemaker

insertion might

> prevent the consequences of bradyarrhythmias including SUDEP. " " This

study

> suggests that patients at high risk for SUDEP should be studied with

subcutaneous

> electronic loop recorders for long periods, or until a potentially

fatal

> arrhythmia is recorded, " they conclude. " These cases show it is

clearly inadequate

> to simply record electrocardiograms for a few weeks or a few seizures. "

>

> The editorialists report no conflict of interest.

>

> The Lancet. 2004; 364:2212-2219

>

> Reviewed by D. Vogin, MD

>

>