Patients with epilepsy who die suddenly do not always have cardiac disease

Langan Y and Sander JW (1999) Patients with epilepsy who die suddenly do not always have cardiac disease. Arch Neurol p. 249.

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Abstract: We read with interest the article by Natelson et al1 but we believe, however, that there are a number of points that need to be raised with respect to other possible mechanisms for sudden unexpected death in epilepsy (SUDEP). While the authors mention that seizures have been associated with cardiac arrhythmias, they do not allude to the fact that apnea, mainly central in nature, has been noted in association with both generalized and partial seizures.2

Context

• Response to Natelson et al. emphasizing the evidence for non-cardiac causes of death, in particular, central apnea, in SUDEP patients. The authors indicate that apnea may cause bradycardia, and point to the fact that most SUDEP deaths are unwitnessed as evidence for a respiratory rather than cardiac cause, as an observer may be able to stimulate respiration by agitation, reducing the death rate in witnessed near-cases. Authors also point to Bird et al. and Johnston et al. as evidence for pulmonary cause.