Patients with epilepsy who die suddenly have cardiac disease

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Natelson BH, Suarez RV, Terrence CF, and Turizo R (1998) Patients with epilepsy who die suddenly have cardiac disease. Arch Neurol 55:6 857–60.

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Abstract: BACKGROUND: Approximately 1 in 1000 patients with epilepsy dies suddenly and unexpectedly with no obvious medical cause. The purpose of this study was to determine if the hearts of such individuals harbor occult cardiac pathology. DESIGN: Following a comprehensive protocol, we performed careful pathologic evaluations of the hearts of 7 patients with epilepsy who died suddenly and 13 previously healthy people who died by hanging or a drug overdose. Hearts were studied only when there was no history or gross anatomical evidence of heart disease or the use of adrenergic drugs. METHODS: Multiple sections of each heart were evaluated independently by 2 cardiac pathologists who were blinded to patient group. RESULTS: Pathologic conditions were found in 5 hearts in the group with epilepsy and in none of the hearts in the comparison group. Four of the 7 hearts in the group with epilepsy had evidence of irreversible pathology in the form of perivascular and interstitial fibrosis. These 4 hearts plus a fifth had evidence of reversible pathology in the form of myocyte vacuolization. Lesions occurred predominantly in the subendocardium. CONCLUSION: Our results support the hypothesis that patients with epilepsy who die suddenly and unexpectedly have cardiac pathologic conditions that may be responsible for their deaths.

Context

  • Examination cardiac pathology following SUDEP in 7 patients. 5 of the hearts were found abnormal by pathologists blinded to the patient’s history, whereas none of 13 hearts from epilepsy-free individuals who died suddenly were found to be abnormal. Myocyte vacuolization and perivascular and interstitial fibrosis were observed. The authors interpret these findings as evidence for longstanding underlying cardiac disease responsible for the deaths of these patients. Cardiac tissue examination also yielded greater evidence of abnormality in SUDEP cases in Tigaran et al., but not in the study of Opeskin et al. In a letter of response, Langan and Sander highlight the evidence for non-cardiac causes, emphasizing central apnea and pulmonary factors.

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