Heart rhythm disturbance in epilepsy may be fatal

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Among some people with epilepsy, potentially fatal heart rhythm abnormalities can occur during a seizure, British investigators report. It is possible that these dangerous rhythms might be prevented with permanently implanted pacemakers.

Dr. John S. Duncan and colleagues at University College London studied 19 patients with a history of seizures, all of whom had been considered for surgical treatment of their epilepsy and were considered to be at high-risk for sudden unexpected death.

The participants were fitted with implantable loop recorders, which can monitor the heart’s electrical activity for up to 18 months.

Over a period of 24 months, 377 seizures occurred, and all 19 patients experienced a racing heart rate during some seizures, the team reports in The Lancet medical journal.

A very slow heart rate occurred during eight seizures in seven participants in the study. Four of these patients who had a severely reduced heart rate or even periods with no heartbeats, had a permanent pacemaker inserted. The device takes over control of the heart rate if it drops too much.

In a related editorial, Drs. Lawrence J. Hirsch and W. Allen Hauser from Columbia University in New York City comment that this study “provides the first real hope” that some cases of sudden unexplained death in people with epilepsy might be preventable.

But because “this strategy might lead to overuse of loop recorders (and) excessive anxiety about a condition that might or might not be preventable,” they say further research is needed before evaluation for a pacemaker becomes routine for people with epilepsy.

SOURCE: Lancet, December 18/25, 2004.

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