Abstracts

Rationale: In recent times, the effect of epilepsy on the heart has become a subject of great interest to Neurologists, particularly since it is believed to be the main mechanism implicated in Sudden Unexpected Death in Epilepsy (SUDEP). It is interesting to note how neurologists had commented on this interaction almost 100 years ago. Methods: Extensive review of the published medical literature from 1827 to 1935. Results: : In 1827, Robert Adams described a seizure in association with bradycardia and cardiac arrest. In 1906 there were two seminal articles published in the Lancet. The first article authored by Russell et al. was titled "Cessation of the Pulse during the onset of Epileptic Fits". He describes a case where after the onset of a seizure, the patient was found to have no pulse. The authors also speculate on the mechanism of cardiac inhibition via the vagus nerve. The second article was authored by J.F. Munson and discusses the action of the heart in an epileptic seizure. The author has used a unique device, a kymograph, to monitor the heart rate in relation to epilepsy. He found no cardiac arrest in the 10 cases he studied, but did find a case where there was a slight slowing of the heart. In the other cases there was tachycardia. . In 1907 Fred High Clarke published an article on occurrence of tachycardia and bradycardia in relation to an epileptic attack. Notkin et al. published an article in American J. Psychiatry in 1932 which described in detail the changes in cardiovascular parameters during a seizure. In this article, three patients had an imperceptible pulse during the seizure. In 1933 W. Penfield described cases where seizures would be accompanied by fall of blood pressure, slowing and weakening of pulse; this was done as part of his Wesley Carpenter Lecture. Conclusions: The interaction between epilepsy and cardiovascular parameters was well documented in a few seminal articles published between 1827 to 1935. It is thus fascinating that interest in investigating this interaction has only been revived recently in light of SUDEP.