Heart rate variability analysis indicates preictal parasympathetic overdrive preceding seizure-induced cardiac dysrhythmias leading to sudden unexpected death in a patient with epilepsy

Jesper Jeppesen, Anders Fuglsang-Frederiksen, Ramon Brugada, Birthe Pedersen, Guido Rubboli, Peter Johansen, Sándor Beniczky

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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 QTc 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.

Original languageEnglish
JournalEpilepsia
Volume55
Issue number7
DOIs
Publication statusPublished - 2014

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Sudden Death
Cardiac Arrhythmias
Epilepsy
Seizures
Heart Rate
Electroencephalography
Malformations of Cortical Development
Cardiopulmonary Resuscitation
Heart Arrest

Keywords

  • Heart rate variability
  • Short QT
  • Sudden unexpected death in epilepsy
  • Video-EEG

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Heart rate variability analysis indicates preictal parasympathetic overdrive preceding seizure-induced cardiac dysrhythmias leading to sudden unexpected death in a patient with epilepsy. / Jeppesen, Jesper; Fuglsang-Frederiksen, Anders; Brugada, Ramon; Pedersen, Birthe; Rubboli, Guido; Johansen, Peter; Beniczky, Sándor.

In: Epilepsia, Vol. 55, No. 7, 2014.

Research output: Contribution to journalArticle

Jeppesen, Jesper ; Fuglsang-Frederiksen, Anders ; Brugada, Ramon ; Pedersen, Birthe ; Rubboli, Guido ; Johansen, Peter ; Beniczky, Sándor. / Heart rate variability analysis indicates preictal parasympathetic overdrive preceding seizure-induced cardiac dysrhythmias leading to sudden unexpected death in a patient with epilepsy. In: Epilepsia. 2014 ; Vol. 55, No. 7.
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