Sudden death in epilepsy : an analysis of potential underlying mechanisms and risk factors

• Main Author: Lamberts, R. J.
• Published: University College London (University of London) 2015
• Subjects: 612.8
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.666813

People with epilepsy have a 16 to 24 fold higher risk of sudden death than the general population. Autonomic dysfunction, cardiac electrical abnormalities, and use of potentially arrhythmic antiepileptic drugs (AEDs) have all been reported in epilepsy and suggest that the heart may be involved. Peri-ictal ventricular arrhythmia has been described in video-EEG recordings of people with severe epilepsy i.e. individuals at high risk of sudden unexpected death in epilepsy (SUDEP): a predominantly seizure-related type of sudden death without known anatomical or toxicological cause. Ventricular tachycardia/ventricular fibrillation (VT/VF) in epilepsy and its association with SUDEP have not yet been investigated in people with less severe epilepsy in the community. Postictal generalized EEG suppression (PGES)>20s after convulsive seizures (CSs) has been proposed as a new SUDEP risk marker, but these results have not been confirmed in a second study. Conflicting findings regarding the value of PGES>20s as a SUDEP risk marker may be explained by high intraindividual variability. I have undertaken three studies to obtain a better understanding of the pathophysiology of sudden death in epilepsy, directly by analysing a potential underlying cardiac mechanism (VT/VF in epilepsy) and evaluating whether this mechanism could be one of the causes of SUDEP in the community. Indirectly, the pathophysiology of sudden death in epilepsy was approached by analysing the intraindividual consistency and the facilitating co-factors of the recently proposed SUDEP risk marker PGES.