Cardiac Arrhythmias and Sudden Unexpected Death in Epilepsy (SUDEP)

Authors

  • POONAM VELAGAPUDI M.D., M.S.,

    1. Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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  • MOHIT TURAGAM M.D.,

    1. Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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  • THOMAS LAURENCE M.D.,

    1. Department of Neurology, College of Medicine, University of Illinois at Urbana Champaign, Urbana, Illinois
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  • ABRAHAM KOCHERIL M.D.

    1. Department of Clinical Cardiac Electrophysiology and Cardiovascular Medicine, College of Medicine, University of Illinois at Urbana Champaign, Urbana, Illinois
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  • No conflict of interest to declare.

Address for reprints: Mohit Turagam, M.D., Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 3116 MFCB, 1685 Highland Avenue, Madison, WI 53705. Fax: 608-265-1420; e-mail: mohitkturagam@gmail.com

Abstract

Sudden unexpected death in epilepsy (SUDEP) is a major clinical problem in epilepsy patients in the United States, especially those with chronic, uncontrolled epilepsy. Several pathophysiological events contributing to SUDEP include cardiac arrhythmias, respiratory dysfunction, and dysregulation of systemic or cerebral circulation. There is a significant body of literature suggesting the prominent role of cardiac arrhythmias in the pathogenesis of SUDEP. There is evidence to say that long-standing epilepsy can cause physiological and anatomical autonomic instability resulting in life-threatening arrhythmias. Tachyarrhythmias, bradyarrhythmias, and asystole are commonly seen during ictal, interictal, and postictal phase in epilepsy patients. It is unclear if these rhythm disturbances need attention as some of them may be just benign findings. Evidence regarding prolonged cardiovascular monitoring or the benefit of pacemaker/defibrillator implantation for primary or secondary prevention in epilepsy patients is limited. Awareness regarding pathophysiology, cardiac effects, and management options of SUDEP will become useful in guiding more individualized treatment in the near future. (PACE 2011; 1–8)

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