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Heart rate variability analysis indicates preictal parasympathetic overdrive preceding seizure‐induced cardiac dysrhythmias leading to sudden unexpected death in a patient with epilepsy
Author(s) -
Jeppesen Jesper,
FuglsangFrederiksen Anders,
Brugada Ramon,
Pedersen Birthe,
Rubboli Guido,
Johansen Peter,
Beniczky Sándor
Publication year - 2014
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12614
Subject(s) - epilepsy , medicine , asystole , electroencephalography , anesthesia , heart rate variability , sudden death , cardiology , qt interval , heart rate , bradycardia , cardiopulmonary resuscitation , resuscitation , blood pressure , psychiatry
Summary Evidence for seizure‐induced cardiac dysrhythmia leading to sudden unexpected death in epilepsy ( SUDEP ) has been elusive. We present a patient with focal cortical dysplasia who has had epilepsy for 19 years and was undergoing presurgical evaluation. The patient did not have any cardiologic antecedents. During long‐term video–electroencephalography ( EEG) monitoring, following a cluster of secondarily generalized tonic–clonic seizures (GTCS), the patient had prolonged postictal generalized EEG suppression, asystole, followed by arrhythmia, and the patient died despite cardiopulmonary resuscitation. Analysis of heart rate variability showed a marked increase in the parasympathetic activity during the period preceding the fatal seizures, compared with values measured 1 day and 7 months before, and also higher than the preictal values in a group of 10 patients with GTCS without SUDEP . The duration of the QT c interval was short (335–358 msec). This unfortunate case documented during video‐ EEG monitoring indicates that autonomic imbalance and seizure‐induced cardiac dysrhythmias contribute to the pathomechanisms leading to SUDEP in patients at risk (short QT interval). A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .