Abstracts

Rationale: Multiple studies have been done examining ictal cardiac abnormalities showing correlations between cardiac arrhythmias and partial epilepsy as well as sudden unexpected death in epilepsy (SUDEP). However there has been little research evaluating the use of long term epilepsy monitoring for cardiac diagnoses, specifically how many patients with a presumed or possible diagnosis of seizures actually had a physiologic, cardiac diagnosis. Methods: This was a retrospective review of a pre-existing epilepsy monitoring unit (EMU) database. Adult patients (>18 years old) admitted to the EMU between 1/1/2007 and 11/1/2012 were queried using cardiac terms such as syncope, cardiac, arrhythmia and bradycardia. Diagnoses were categorized using the following classification: 1) Epileptic seizures 2) Non-epileptic events (clear psychogenic, clear physiologic including migraine, panic attack and cardiac, and unclear) 3) Unclear, no events captured. Additional factors were examined including age, gender, past medical history, epilepsy risk factors, prior EEG and MRI brain results and medications on admissions (past and current antiepileptics) to see if any of these factors may help predict a cardiac diagnosis.Results: Initial database query revealed 1036 unique admissions to the EMU during the five year period. 44 patients were identified as having a probable cardiac diagnosis. Of these, 1 patient was epileptic, 24 were non epileptic (6 psychogenic, 6 cardiac, 2 panic attacks, 10 unclear) and 19 were unclear, no events captured. Of the 6 cardiac patients, 2 were diagnosed with presyncope, 1 with syncope, 2 with arrhythmias (PVC and bradycardia) and 1 with asystole. Demographically the mean age was 47 (18-65) with 4 men and 2 women. 5 did not report any epilepsy risk factors and 1 reported a history of a meningioma. 4 had hypertension, 3 had hyperlipidemia and 4 had a psychiatric diagnosis including anxiety, depression or bipolar disorder. All 6 had not been on any antiepileptic medications in the past however, 1 patient was on topiramate at admission for migraines and 2 were on levetiracetam. 5 reported normal EEGs in the past with 1 having an abnormal EEG. This abnormal EEG was read at an outside hospital however, the patient's 6 day continuous video EEG was normal. 3 had normal MRI brains, 2 had no prior MRIs and 1 abnormal MRI with a meningioma and small vessel disease. Conclusions: For those admitted and found to have a cardiac diagnosis, this may be a useful diagnostic tool. For example, a patient in this study was found to have asystole and was referred to have a pacemaker placed. Additionally, this study confirmed that patients with cardiac diagnoses will likely have normal EEG and MRI findings, will be on few anti-epileptic medications and may have hypertension and hyperlipidemia. There were fewer patients with definitive cardiac diagnoses than expected. This may be due to good screening and cardiac evaluation prior to inpatient EEG monitoring. Also, many patients in this study in the 'Unclear, no events captured' or 'Non-epileptic unclear' category may have had a cardiac diagnosis.