PATIENTS WITH EPILEPSY WHO DIE SUDDENLY HAVE CARDIAC DISEASE

Background: Approximately 1 in 1000 patients with epilepsy dies sudden ly and unexpectedly with no obvious medical cause. The purpose of this study was to determine if the hearts of such individuals harbor occul t cardiac pathology. Design: Following a comprehensive protocol, we pe rformed careful pathologic evaluations of the hearts of 7 patients wit h epilepsy who died suddenly and 13 previously healthy people who died by hanging or a drug overdose. Hearts were studied only when there wa s no history or gross anatomical evidence of heart disease or the use of adrenergic drugs. Methods: Multiple sections of each heart were eva luated independently by 2 cardiac pathologists who were blinded to pat ient group. Results: Pathologic conditions were found in 5 hearts in t he group with epilepsy and in none of the hearts in the comparison gro up. Four of the 7 hearts in the group with epilepsy had evidence of ir reversible pathology in the form of perivascular and interstitial fibr osis. These 4 hearts plus a fifth had evidence of reversible pathology in the form of myocyte vacuolization. Lesions occurred predominantly in the subendocardium. Conclusion: Our results support the hypothesis that patients with epilepsy who die suddenly and unexpectedly have car diac pathologic conditions that may be responsible for their deaths.