Effects of seizures on cardiac function.

To the Editor: We read with interest Steven Scheule’s review, Effects of Seizures on Cardiac Function (Schuele, 2009). Sudden unexpected death in epilepsy is an important cause of death in young persons with uncontrolled epilepsy. The mechanism is not well understood. We reported a case of near sudden unexpected death in epilepsy earlier this year (Espinosa et al., 2009), which demonstrates that a patient with epilepsy can develop an ictal malignant arrhythmia as a possible cause of sudden unexpected death in epilepsy even in the absence of any cardiac disease. Our patient had a single prolonged left temporal partial seizure with secondary generalization after 7 days of video electroencephalogram monitoring with medication reduction. The single-lead electrocardiography initially revealed sinus tachycardia to 180 beats per minute during the seizure. At its conclusion, there was rapid ventricular tachycardia degenerating into pulseless ventricular fibrillation that required cardiopulmonary resuscitation. There was no evidence of respiratory failure before the cardiac arrhythmia. Transthoracic echocardiogram, cardiac catheterization, cardiac electrophysiology study, and cardiac enzymes were unrevealing. Our case demonstrates that partial seizures clearly can lead to a near fatal arrhythmia in the absence of cardiac disease and should be considered as a possible cause of sudden unexpected death in epilepsy.