Abstracts

Rationale: Cardiac arrhythmia is a candidate pathophysiological mechanism for sudden unexpected death in epilepsy (SUDEP). Male gender, refractory epilepsy, history of generalized tonic clonic seizure (GTCS), and polytherapy are established epidemiological SUDEP risk factors. The goal of this study was to explore correlations between abnormalities detected by routine electrocardiogram (ECG) and the principal SUDEP epidemiological risk factors. Methods: The study was approved by the Baylor College of Medicine IRB. The study inclusion criteria were satisfied in 108 of 356 patients. The ECGs reviewed by cardiology specialist according to the standard hospital practice were classified based on the accepted cardiologic diagnostic classification as normal, abnormal, and borderline. Results: Forty-four percent of the ECG studies were abnormal and variable degree of cardiac repolarization dysfunction was the most commonly observed feature (42%). The risk for abnormal ECG correlated with treatment resistance (chi2=4.26, df1, p=0.039) but not with gender, seizure type or treatment load. The treatment resistance in the group with abnormal ECG correlated with polytherapy (FET 2-tailed, p=0.03). Abnormal ECG was 1.5 times more common in females than males affected by generalized epilepsy (45% vs. 28%, respectively) although the difference did not reach statistical significance. Conclusions: This study corroborated previously published research in demonstrating the substantial prevalence of cardiac abnormalities in patients with epilepsy. We showed that patients with treatment resistant epilepsy seem to be especially vulnerable to abnormalities on routine ECG and routine surveillance of this patient population ought to be considered in clinical practice. Source of funding:This study was supported by 1R01NS067013 (NINDS) (AMG), 1P20NS076916 (AMG), Fiorito Fund for SUDEP Research (AMG), Emma Bursick Memorial Fund (AMG), and SUDEP Research Funding (AMG).