Centro de Cirurgia de Epilepsia (CIREP), Departamento de Neurociencias e Ciencias do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
Cardiol J. 2011;18(2):194-6.
The incidence of sudden unexpected death in epilepsy (SUDEP) has been estimated from 0.5-1.4/1,000 person-years in people with treated epilepsy, and 9/1,000 person-years in candidates for epilepsy surgery. Potential risk factors for SUDEP include: age, early onset of epilepsy, duration of epilepsy, uncontrolled seizures, seizure type and winter temperatures. The arrythmogenic side-effect of antiepileptic drugs and seizures may increase the risk of SUDEP. In this report, we describe a patient with prolonged post-ictal tachycardia in EEG video recordings with a typical case of SUDEP: a 16-year-old boy with medically intractable complex partial seizures. Magnetic resonance imaging revealed left mesial temporal sclerosis. During non-invasive video-EEG monitoring, the patient presented a post-ictal heart rate increased for five hours. Two months after video-EEG, he died from SUDEP during a tonic-clonic secondary generalized seizure. The possibility of cardiac involvement in the pathogenesis of SUDEP has been suggested by many studies. Evaluation of this patient with EEG-video monitoring, including measurement of heart rate, contributed to an identification of ictal tachycardia that may have played a role in the SUDEP. Premature mortality seems to be increased in patients with epilepsy, and cardiac abnormalities may be a possible cause of SUDEP.
癫痫猝死症 (SUDEP) 的发病率估计为：经治疗的癫痫患者中每 1000 人年有 0.5-1.4 例，癫痫手术候选人中每 1000 人年有 9 例。SUDEP 的潜在危险因素包括：年龄、癫痫早期发病、癫痫持续时间、无法控制的癫痫发作、癫痫发作类型和冬季温度。抗癫痫药物的致心律失常副作用和癫痫发作可能会增加 SUDEP 的风险。在本报告中，我们描述了一名患者的脑电图视频记录中有长时间的癫痫后心动过速，这是一个典型的 SUDEP 病例：一名 16 岁男孩患有药物难治性复杂部分性癫痫发作。磁共振成像显示左侧内侧颞叶硬化。在非侵入性视频脑电图监测期间，患者出现了持续五小时的癫痫后心率增加。视频脑电图两个月后，他死于一次强直-阵挛性全身发作的 SUDEP。许多研究表明，心脏参与 SUDEP 的发病机制的可能性。对该患者进行脑电图视频监测，包括心率测量，有助于识别可能在 SUDEP 中起作用的癫痫后心动过速。癫痫患者的过早死亡率似乎增加，心脏异常可能是 SUDEP 的一个可能原因。
