Electrocardiographic disorders associated to recent onset epilepsy

González Martínez F, Navarro Gutiérrez S, de León Belmar JJ, and Valero Serrano B (2005) Electrocardiographic disorders associated to recent onset epilepsy. Neurologia 20:10 698–701.

Link to Article

Abstract: INTRODUCTION: Patients who suffer seizures sometimes have electrocardiographic disorders during both the seizure and the post-critical period. The incidence of sudden death in epileptic patients (SUDEP) is greater than that observed in non-epileptic patients, there being evidence of respiratory disorders, cardiac arrhythmias, encephalic involvement and coronary ischemia during the seizures. This coronary ischemia has been mainly described in patients with drug refractory epilepsy, it being quite rare in patients without background of refractory seizures. During the seizure and in the post-critical period, changes have also been described in the ST segment. This suggests that the stimulation of the autonomic system may create the adequate substrate to cause myocardial ischemia. In this situation, ventricular arrhythmias and serious myocardial dysfunction may be observed. Besides the ischemia, on other occasions, there are alterations in the heart rhythm, it being possible to observe different effects and arrhythmias in the same patient. CLINICAL CASE: We present the case of a 50 year old male in whom electrocardiographic alterations with depression of the ST segment, without arrhythmias, were observed immediately after his first seizures. CONCLUSION: In some cases, cardiac alterations previously unknown in epileptic patients could explain the unexpected deaths of epileptics in SUDEP diagnosed cases.

Context

• Single-case report and review of the literature. The patient reported experienced ST-segment depressions without arrhythmia after his first seizure, implying a link between seizure and myocardial ischemia or infarction that could explain some cases of SUDEP.