Sudden cardiac arrest in people with epilepsy in the community: Circumstances and risk factors

Robert J Lamberts, Marieke T Blom, Merel Wassenaar, Abdennasser Bardai, Frans S Leijten, Gerrit-Jan de Haan, Josemir W Sander, Roland D Thijs, Hanno L Tan

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To ascertain whether characteristics of ventricular tachycardia/fibrillation (VT/VF) differed between people with epilepsy and those without and which individuals with epilepsy were at highest risk.

METHODS: We ascertained 18 people with active epilepsy identified in a community-based registry of sudden cardiac arrest (SCA) with ECG-confirmed VT/VF (cases). We compared them with 470 individuals with VT/VF without epilepsy (VT/VF controls) and 54 individuals with epilepsy without VT/VF (epilepsy controls). Data on comorbidity, epilepsy severity, and medication use were collected and entered into (conditional) logistic regression models to identify determinants of VT/VF in epilepsy.

RESULTS: In most cases, there was an obvious (10/18) or presumed cardiovascular cause (5/18) in view of preexisting heart disease. In 2 of the 3 remaining events, near-sudden unexpected death in epilepsy (SUDEP) was established after successful resuscitation. Cases had a higher prevalence of congenital/inherited heart disease (17% vs 1%, p = 0.002), and experienced VT/VF at younger age (57 vs 64 years, p = 0.023) than VT/VF controls. VT/VF in cases occurred more frequently at/near home (89% vs 58%, p = 0.009), and was less frequently witnessed (72% vs 89%, p = 0.048) than in VT/VF controls. Cases more frequently had clinically relevant heart disease (50% vs 15%, p = 0.005) and intellectual disability (28% vs 1%, p < 0.001) than epilepsy controls.

CONCLUSION: Cardiovascular disease rather than epilepsy characteristics is the main determinant of VT/VF in people with epilepsy in the community. SCA and SUDEP are partially overlapping disease entities.

Original languageEnglish
Pages (from-to)212-218
Number of pages7
JournalNeurology
Volume85
Issue number3
DOIs
Publication statusPublished - 21 Jul 2015

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases
  • Case-Control Studies
  • Cross-Sectional Studies
  • Death, Sudden, Cardiac
  • Epilepsy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Registries
  • Residence Characteristics
  • Risk Factors
  • Young Adult

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