Abstract 16078: Sudden Cardiac Arrest in Patients with Epilepsy: How Often is it Triggered by a Seizure?
Introduction: Higher prevalence of sudden cardiac arrest (SCA) in the setting of seizure disorder is well recognized among cohorts of patients with epilepsy (sudden unexpected death in epilepsy - SUDEP). We investigated the commonly held belief that SUDEP is triggered by a terminal seizure event.
Methods: From a large ongoing population-based prospective study of SCA in the Northwest US we performed a comprehensive evaluation of SCA circumstances and lifetime medical history in the subgroup of patients with a diagnosis of seizure disorder. Information was obtained during 2002-2011 using multiple sources (first responders, medical practitioners and medical examiner) and patients with infantile febrile seizures or alcoholic withdrawal seizures were excluded.
Results: There were 106 patients with SCA and history of seizure disorder; 31 (29%) had witnessed SCA with sufficient bystander information to determine whether there was seizure activity immediately preceding the event. Of the 31, 19 (61%) were male and mean age was 56 ± 22 years old. Evidence of seizure activity was only present in 12 (39%). Of the 26 patients in whom resuscitation was attempted, only 2 (8%) survived to hospital discharge. The initial rhythm recorded during SCA was nearly equally distributed between VT/VF (35%), PEA (30%) and asystole (35%). This was similar to the overall group of SCA patients (VT/VF in 39%, PEA in 23% and asystole in 36%; survival to hospital discharge 8%).
Conclusion: In the majority of patients with a history of seizure disorder, seizure activity was not observed to be a trigger for SCA. These findings are discordant with the prevailing belief that terminal seizures precedes SUDEP and suggest the existence of diverse pathways to ventricular arrhythmogenesis in patients with epilepsy.
- © 2012 by American Heart Association, Inc.