title: Sudden unexpected death in an adolescent with epilepsy: all roads lead to the heart?
abstract: The incidence of sudden unexpected death in epilepsy (SUDEP) has been estimated from 0.5-1.4/1,000 person-years in people with treated epilepsy, and 9/1,000 person-years in candidates for epilepsy surgery. Potential risk factors for SUDEP include: age, early onset of epilepsy, duration of epilepsy, uncontrolled seizures, seizure type and winter temperatures. The arrythmogenic side-effect of antiepileptic drugs and seizures may increase the risk of SUDEP. In this report, we describe a patient with prolonged post-ictal tachycardia in EEG video recordings with a typical case of SUDEP: a 16-year-old boy with medically intractable complex partial seizures. Magnetic resonance imaging revealed left mesial temporal sclerosis. During non-invasive video-EEG monitoring, the patient presented a post-ictal heart rate increased for five hours. Two months after video-EEG, he died from SUDEP during a tonic-clonic secondary generalized seizure. The possibility of cardiac involvement in the pathogenesis of SUDEP has been suggested by many studies. Evaluation of this patient with EEG-video monitoring, including measurement of heart rate, contributed to an identification of ictal tachycardia that may have played a role in the SUDEP. Premature mortality seems to be increased in patients with epilepsy, and cardiac abnormalities may be a possible cause of SUDEP.
authors: Centro de Cirurgia de Epilepsia (CIREP), Departamento de Neurociencias e Ciencias do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors: Kylvia G F D
authors: KG
authors: Pinto
authors: Fulvio A
authors: FA
authors: Scorza
authors: Ricardo M
authors: RM
authors: Arida
authors: Esper A
authors: EA
authors: Cavalheiro
authors: Luciana D
authors: LD
authors: Martins
authors: Helio R
authors: HR
authors: Machado
authors: Américo C
authors: AC
authors: Sakamoto
authors: Vera C
authors: VC
authors: Terra
mesh_terms: D000293:Adolescent; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D012307:Risk Factors; D013610:Tachycardia / Q000209:etiology* / Q000401:mortality; D014743:Videotape Recording