Abstracts

Rationale: Cardiopulmonary dysfunction and postictal generalized suppression are possible risk factors for the occurrence of sudden unexpected death in epilepsy (SUDEP). The possible relationship between cardiorespiratory abnormalities and unprovoked seizures has been hypothesized by many authors but not been systematically studied.While epilepsy usually starts in childhood, SUDEP is more frequently seen in adults. There is limited data of the effect of brain maturation and EEG suppression. Methods: The purpose of this preliminary report is to identify possible risk factors in children with recurrent seizures and near-death. We report two youngsters with recorded cardiac abnormalities during the post-ictal state documented with prolonged Video EEG (VEEG) recording and conventional EKG monitoring during elective epilepsy monitoring unit admission. The first patient is twelve year-old boy with a diagnosis of myoclonic -astatic epilepsy presenting with recurrent seizures despite of therapeutic doses of valproic acid, clonazepam and lamotrigine. During VEEG recording, one typical seizure revealed general ictal onset, post ictal slowing, diffuse suppression of the background and cardiac asystole. The second case is a seventeen year-old boy with frontal lobe epilepsy presenting with multiple seizures, despite adequate doses of lamotrigine and carbamazepine. VEEG monitoring captured a seizure with a frontal ictal onset followed by post-ictal slowing, diffuse attenuation of the background and cardiac asystole. Both patients underwent continuous Holter monitoring and cardiac pacemaker procedures. Results: Among the possible risk factors for SUDEP (seizures, respiratory factors, cerebral shutdown, cardiac factors), our study revealed cardiac asystole occurring during the postictal state. We propose a cardiac repolarization abnormality leading to a brady-arrhythmia and asystole. Also, there may be an age-related effect on cardiac abnormalities in children with poorly controlled epilepsy associated with SUDEP. Conclusions: Patients with poorly controlled seizures may experience chronic changes in the brain-stem areas that regulate cardiac functions secondary to autonomic changes. Cardiac asystole may be the terminal point of a cascade of autonomic changes occurring in children with poorly controlled seizures. The aforementioned findings may increase the risk of SUDEP in patients with pharmaco-resistant epilepsy