Patients with epilepsy who die suddenly have cardiac disease.

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.

[1]  M. Samuels,et al.  Neurogenic heart disease: a unifying hypothesis. , 1987, American Journal of Cardiology.

[2]  B. Natelson,et al.  Neurocardiology update: role of the nervous system in coronary vasomotion. , 1995, Cardiovascular research.

[3]  J A Perper,et al.  Unexpected, unexplained death in epileptic patients , 1975, Neurology.

[4]  G. Baroldi.  Different types of myocardial necrosis in coronary heart disease: a pathophysiologic review of their functional significance. , 1975, American heart journal.

[5]  J E Leestma,et al.  A prospective study on sudden unexpected death in epilepsy , 1989, Annals of neurology.

[6]  S. I. Cohen,et al.  Cardiac manifestations of complex partial seizures. , 1986, The American journal of medicine.

[7]  B. Natelson.  Neurocardiology. An interdisciplinary area for the 80s. , 1985, Archives of neurology.

[8]  B. Natelson,et al.  Sudden death. A neurocardiologic phenomenon. , 1993, Neurologic clinics.

[9]  W. Hauser,et al.  ECG abnormalities in patients with epilepsy , 1987, Neurology.

[10]  S. Mayer,et al.  Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. , 1995, Journal of neurosurgery.

[11]  G. Hutchins,et al.  Myocyte vacuolization in infarct border zones is reversible. , 1985, The American journal of pathology.

[12]  P. Schraeder,et al.  Autonomic Dysfunction in Epilepsy: Characterization of Autonomic Cardiac Neural Discharge Associated with Pentylenetetrazol‐Induced Epileptogenic Activity , 1982, Epilepsia.

[13]  B. Natelson.  Coronary vasospasm: a neuro-behavioral event? , 1987, Medical hypotheses.

[14]  L. D. Blumhardt,et al.  ELECTROCARDIOGRAPHIC ACCOMPANIMENTS OF TEMPORAL LOBE EPILEPTIC SEIZURES , 1986, The Lancet.

[15]  J. Annegers,et al.  Cohort Study of Incidence of Sudden Unexplained Death in Persons with Seizure Disorder Treated with Antiepileptic Drugs in Saskatchewan, Canada , 1995, Epilepsia.