&lt;p&gt;A case of near-sudden unexpected death in epilepsy due to ventricular fibrillation&lt;/p&gt;

Seo, Myung Ha; Sung, Won Young

doi:10.2147/oaem.s214619

Cited by 14 publications

(13 citation statements)

References 18 publications

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“…Seizure-induced ventricular tachycardia or fibrillation (VT/VF) were described in six cases that led to SUDEP or near-SUDEP [54][55][56][57][58][59]. In all these cases, VT/VF occurred directly after a TCS.…”

Section: Ictal Ventricular Tachycardia or Fibrillationmentioning

confidence: 99%

Identifying patients with epilepsy at high risk of cardiac death: signs, risk factors and initial management of high risk of cardiac death

Surges

Shmuely

Dietze³

et al. 2021

Epileptic Disorders

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People with epilepsy have a threefold increased risk of dying prematurely, and a significant proportion is due to sudden cardiac death or acute myocardial infarctions. The causes of increased cardiovascular morbidity and mortality in epilepsy are manifold and include acute or remote effects of epileptic seizures, the longstanding epilepsy itself or antiseizure treatments. Seizurerelated cardiac arrhythmias are common and comprise bradyarrhythmia and asystole, atrial fibrillation and ventricular tachycardia. The most frequent clinically relevant seizure-related arrhythmia is ictal asystole that may require implantation of a cardiac pacemaker, whereas seizure-related ventricular tachycardias are only rarely reported. Takotsubo cardiomyopathy and myocardial infarction are rare complications and predominantly described in association with tonic-clonic seizures. Epilepsy-related cardiac complications include a disturbed cardiac autonomic nervous system and acquired dysfunction of the heart (recently defined as 'epileptic heart'), probably contributing to the abnormalities of cardiac repolarisation and elevated risk of sudden cardiac death in people with epilepsy. If successful, the use of antiseizure medication prevents seizure-related cardiac arrhythmias and remote cardiac complications. However, enzyme-inducing antiseizure medications have a negative impact on cardiovascular risk factors, which may further be aggravated by weight gain linked to specific antiseizure drugs. Given the severe consequences of cardiac risks, the aim of this educational review is to explain the many facets of cardiac complications and their underlying causes, and to enable the reader to recognize and manage these risks with the goal to mitigate the cardiac risks in people with epilepsy. Features of syncope are explained in detail, as syncope of all origins can be mistaken as epileptic seizures in people with or without epilepsy, and ictal syncope (i.e. seizure-induced syncope) can easily be ignored.

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Section: Ictal Ventricular Tachycardia or Fibrillationmentioning

confidence: 99%

Identifying patients with epilepsy at high risk of cardiac death: signs, risk factors and initial management of high risk of cardiac death

Surges

Shmuely

Dietze³

et al. 2021

Epileptic Disorders

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“…In other previous case reports, most patients with SUDEP suffered from chronic, intractable seizures that are uncontrollable and of relatively long duration despite the use of antiepileptic drugs [ 27 ]. In rare case, the patient with near-SUDEP had no history of epileptic seizures and only reported of the inability to sleep well due to a burning sensation in the foot [ 28 ]. Therefore, it can be speculated that SUDEP can occur early in the course of epilepsy or even in patients with few seizures.…”

Section: Discussionmentioning

confidence: 99%

Near-sudden unexpected death in a patient with epilepsy undergoing hemodialysis: a case report

Hatano¹,

Kanzaki

Marumoto

et al. 2021

CEN Case Rep

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Sudden unexpected death in epilepsy (SUDEP) has been defined as a sudden/unexpected, witnessed/unwitnessed, nontraumatic, and nondrowning death in epileptic patients with/without seizure evidence and documented status epilepticus. Identified as the leading cause of epilepsy-related deaths, SUDEP cases are highly unrecognized and underreported due to diagnostic difficulty. We report a case of a successfully revived hemodialysis patient who developed cardiopulmonary arrest after a witnessed convulsive seizure. Electroencephalogram revealed epileptic abnormalities. Therefore, this case could be seizure-induced cardiopulmonary arrest and near-SUDEP. Hence, the possibility of SUDEP should be considered even in hemodialysis patients having conventional coronary risk factors for sudden cardiac death.

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“…Prolongation of QTc can provoke potentially lethal tachyarrhythmias, 33 but whether peri‐ictal QTc‐prolongation relates to SUDEP is unclear. Only two SUDEP and four near SUDEP cases in which tachyarrhythmias played a role have been reported 37‐39 . A prospective study of out‐of‐hospital cardiac arrests due to ECG‐documented ventricular tachycardia or fibrillation showed a threefold increased risk of these arrhythmias in people with epilepsy compared to the general population 40 .…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrhythmias in Dravet syndrome: an observational multicenter study

Shmuely

Surges

Helling

et al. 2020

Ann Clin Transl Neurol

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Objectives: We ascertained the prevalence of ictal arrhythmias to explain the high rate of sudden unexpected death in epilepsy (SUDEP) in Dravet syndrome (DS). Methods: We selected cases with clinical DS, ≥6 years, SCN1A mutation, and ≥1 seizure/week. Home-based ECG recordings were performed for 20 days continuously. Cases were matched for age and sex to two epilepsy controls with no DS and ≥1 major motor seizure during video-EEG. We determined the prevalence of peri-ictal asystole, bradycardia, QTc changes, and effects of convulsive seizures (CS) on heart rate, heart rate variability (HRV), and PR/QRS. Generalized estimating equations were used to account for multiple seizures within subjects, seizure type, and sleep/wakefulness. Results: We included 59 cases. Ictal recordings were obtained in 45 cases and compared to 90 controls. We analyzed 547 seizures in DS (300 CS) and 169 in controls (120 CS). No asystole occurred. Postictal bradycardia was more common in controls (n = 11, 6.5%) than cases (n = 4, 0.7%; P = 0.002). Peri-ictal QTc-lengthening (≥60ms) occurred more frequently in DS (n = 64, 12%) than controls (n = 8, 4.7%, P = 0.048); pathologically prolonged QTc was rare (once in each group). In DS, interictal HRV was lower compared to controls (RMSSD P = 0.029); periictal values did not differ between the groups. Prolonged QRS/PR was rare and more common in controls (QRS: one vs. none; PR: three vs. one). Interpretation: We did not identify major arrhythmias in DS which can directly explain high SUDEP rates. Peri-ictal QTc-lengthening was, however, more common in DS. This may reflect unstable repolarization and an increased propensity for arrhythmias. 462

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<p>A case of near-sudden unexpected death in epilepsy due to ventricular fibrillation</p>

Cited by 14 publications

References 18 publications

Identifying patients with epilepsy at high risk of cardiac death: signs, risk factors and initial management of high risk of cardiac death

Identifying patients with epilepsy at high risk of cardiac death: signs, risk factors and initial management of high risk of cardiac death

Near-sudden unexpected death in a patient with epilepsy undergoing hemodialysis: a case report

Cardiac arrhythmias in Dravet syndrome: an observational multicenter study

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