Cardiovascular causes of loss of consciousness in patients with presumed epilepsy: A cause of the increased sudden death rate in people with epilepsy?

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Abstract

background, methods, and results: Syncope and seizures are often indistinguishable clinically. We present a series of 12 patients diagnosed as having epilepsy. Despite normal or nonspecific electroencephalographic findings, 11 of 12 patients were treated or offered treatment with long-term anticonvulsant agents. Subsequently, diagnoses of arrhythmic or neurally mediated syncope were made in all patients using Holter monitoring, long-term ambulatory loop electrocardiographic recording, or tilttable studies. Arrhythmias included torsades de pointes (four patients), atrioventricular nodal reentrant supraventricular tachycardia (one patient), and sinus arrest (two patients). The remaining five patients had neurally mediated syncope with hypotension and bradycardia, including asystole in two patients. Treatment for the documented cardiovascular abnormalities resulted in the alleviation of syncopal symptoms.

conclusions: Because the observed cardiovascular abnormalities are potentially fatal, this series suggests that undiagnosed cardiac syncope may contribute to the documented increased sudden death rate in patients with presumed epilepsy. Cardiac causes of loss of consciousness should be considered in patients with presumed epilepsy, atypical premonitory symptoms (such as nausea, lightheadedness, or palpitations), nondiagnostic electroencephalograms, and failure to respond to anticonvulsant therapy.

References (37)

  • Abi-SamraF et al.

    The usefulness of head-up tilt testing and hemodynamic investigations in the workup of syncope of unknown origin

    PACE

    (1988)
  • ManolisA et al.

    Syncope: current diagnostic evaluation and management

    Ann Intern Med

    (1990)
  • AnnegersJF et al.

    Patterns of overall and unexplained death among persons with epilepsy

  • LeestmaJE et al.

    Sudden unexpected death associated with seizures: analysis of 66 cases

    Epilepsia

    (1984)
  • DasheiffRM et al.

    Sudden unexpected death of epileptic patients due to cardiac arrhythmia after seizure

    Arch Neurol

    (1986)
  • HirschCS et al.

    Unexpected death in young epileptics

    Neurology

    (1971)
  • DasheiffRM

    Sudden unexpected death in epilepsy: a series from an epilepsy surgery program and speculation on the relationship to sudden cardiac death

    J Clin Neurophysiol

    (1991)
  • GilchristJM

    Arrhythmogenic seizures: diagnosis by simultaneous EEG and ECG recording

    Neurology

    (1985)
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    The work of Simon Ho was supported by a grant from the National Institute of Health National Center Research Resources, General Clinical Research Center, New England Medical Center, Boston, Massachusetts (grant no. M01-RR00054.)

    The loop recorder for Patient 4 was provided by Instromedix, Inc., Hillsboro, Oregon.

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