title: EEG and ECG in sudden unexplained death in epilepsy.
abstract: OBJECTIVE
  Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality for patients with epilepsy. Cardiac factors may be involved and were evaluated in this study.
  
  
  METHODS
  EEG and ECG data for 21 patients with definite (n = 6) or probable (n = 15) SUDEP were compared with data from a group of 43 patients with refractory partial epilepsy. ECG abnormalities and heart rate (HR) changes were correlated with clinical data.
  
  
  RESULTS
  Fourteen patients died in their sleep; two were awake. Ictal maximal HR (90 seizures from 16 of 21 patients) was significantly higher in SUDEP (mean, 149 beats/min, BPM) than in comparison patients (mean, 126 BPM; p < 0.001). Greater increases in HR were associated with seizures arising from sleep (78 BPM increase) than from wakefulness (47 BPM; p < 0.001) in SUDEP, as compared with the non-SUDEP group (52 BPM in sleep, 43 BPM in wakefulness; p = 0.27). Ictal cardiac repolarization and rhythm abnormalities occurred in 56% of SUDEP (including two atrial fibrillation, two ventricular premature depolarizations, two marked sinus arrhythmia, two atrial premature depolarizations, one junctional escape, one ST-segment elevation), and 39% of comparison patients (p = 0.39). No specific seizure onset (laterality or lobe) was associated with SUDEP.
  
  
  CONCLUSIONS
  This study reveals, for the first time, evidence of increased autonomic stimulation (as measured by HR) associated with seizures, particularly in sleep, in patients with SUDEP, as compared with a clinically similar group of patients with refractory epilepsy.
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Jefferson Medical College, Philadelphia, Pennsylvania, USA. maromi.nei@jefferson.edu
authors.forename: Maromi
authors.initials: M
authors.lastname: Nei
authors.forename: Reginald T
authors.initials: RT
authors.lastname: Ho
authors.forename: Bassel W
authors.initials: BW
authors.lastname: Abou-Khalil
authors.forename: Frank W
authors.initials: FW
authors.lastname: Drislane
authors.forename: Joyce
authors.initials: J
authors.lastname: Liporace
authors.forename: Alicia
authors.initials: A
authors.lastname: Romeo
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sperling
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D003645:Death, Sudden / Q000453:epidemiology; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data; D004827:Epilepsy / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged