Heart rate variability analysis indicates preictal parasympathetic overdrive preceding seizure-induced cardiac dysrhythmias leading to sudden unexpected death in a patient with epilepsy.
Evidence for seizure-induced cardiac dysrhythmia leading to sudden unexpected death in epilepsy (SUDEP) has been elusive. We present a patient with focal cortical dysplasia who has had epilepsy for 19 years and was undergoing presurgical evaluation. The patient did not have any cardiologic antecedents. During long-term video-electroencephalography (EEG) monitoring, following a cluster of secondarily generalized tonic-clonic seizures (GTCS), the patient had prolonged postictal generalized EEG suppression, asystole, followed by arrhythmia, and the patient died despite cardiopulmonary resuscitation. Analysis of heart rate variability showed a marked increase in the parasympathetic activity during the period preceding the fatal seizures, compared with values measured 1 day and 7 months before, and also higher than the preictal values in a group of 10 patients with GTCS without SUDEP. The duration of the QTc interval was short (335-358 msec). This unfortunate case documented during video-EEG monitoring indicates that autonomic imbalance and seizure-induced cardiac dysrhythmias contribute to the pathomechanisms leading to SUDEP in patients at risk (short QT interval).
Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
Jesper
J
Jeppesen
Anders
A
Fuglsang-Frederiksen
Ramon
R
Brugada
Birthe
B
Pedersen
Guido
G
Rubboli
Peter
P
Johansen
Sándor
S
Beniczky
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D002648:Child; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D012640:Seizures / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D055815:Young Adult
Heart rate variability; Short QT; Sudden unexpected death in epilepsy; Video-EEG