Sudden cardiac arrest in people with epilepsy in the community
Circumstances and risk factors
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.
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Information & Authors
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Copyright
© 2015 American Academy of Neurology.
Publication History
Received: September 15, 2014
Accepted: February 10, 2015
Published online: June 19, 2015
Published in print: July 21, 2015
Disclosure
R. Lamberts, M. Blom, M. Wassenaar, A. Bardai, F. Leijten, and G. de Haan report no disclosures relevant to the manuscript. J. Sander receives research support from the Dr. Marvin Weil Epilepsy Research Fund, Eisai, GSK, EU FP7, and WHO, and has been consulted by and received fees for lectures from GSK, Eisai, Lundbeck, Teva, and UCB. R. Thijs receives research support from NUTS Ohra Fund, Medtronic, and AC Thomson Foundation, and has received fees for lectures from Medtronic, UCB Pharma, and GSK. H. Tan reports no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Study Funding
Supported by the Dutch National Epilepsy Fund (project number 10-07), Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie (Nederland), and Netherlands Organization for Scientific Research (NWO, grant ZonMW Vici 918.86.616).
Authors
Author Contributions
The study was conceptualized and designed by R.J.L., M.T.B., A.B., J.W.S., R.D.T., and H.L.T. Data were collected by R.J.L., M.T.B., M.W., and A.B. Data analysis and interpretation was by R.J.L., M.T.B., M.W., F.S.L., G.-J.d.H., J.W.S., H.L.T., and R.D.T. The paper was drafted by R.J.L., M.T.B., J.W.S., R.D.T., and H.L.T. All authors approved the submitted version. R.D.T. and H.L.T. are the guarantors.
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