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Pacemakers "could protect people with epilepsy from sudden unexpected death"

6 January, 2005

Results of a study, published in the medical journal The Lancet,
highlight how interruptions to the heart's rhythm is an under-reported
consequence of seizures, and that the use of cardiac pacemakers by some
people with epilepsy could play a future role in protecting against
Sudden Unexpected in Epilepsy (SUDEP).

People
with epilepsy are at risk of sudden unexpected death and the
researchers have said that irregular heart rhythm as a result of
neurological dysfunction during seizures is thought to be a possible
cause.

Professor John Duncan, from the Institute of Neurology,
and colleagues studied 20 people with epilepsy who received an
implantable device which monitored heart rhythms. These devices were
programmed to record automatically when very slow heart beats
(bradycardia, 40 beats per minute or less) or very fast beats
(tachycardia, 140 beats or more per minute) were detected.

Patients
were studied for up to 22 months and ECG patterns monitored heart
rhythms during 377 seizures. Heart rate during seizures exceeded 100
beats per minute among 16 patients. Four patients had bradycardia or
periods of asystole (cardiac inactivity) and were given permanent
pacemaker insertion. Three of these four patients had potentially fatal
asystole.

Professor Duncan said:

'We
have shown that implantable loop recorders can identify potentially
fatal cardiac abnormalities in patients with epilepsy, and suggest that
the incidence of bradycardia and asystole has previously been
under-reported. Asystole underlies a proportion of sudden unexpected
deaths in epilepsy, which could be prevented by cardiac-pacemaker
insertion.'

Simon Wigglesworth, deputy chief executive of Epilepsy Action, commented:

'We
welcome this important research, which will affect a small number of
people with epilepsy at risk of potentially fatal pauses in heart
rhythms during a seizure. We hope that the larger study proves
successful in identifying patients with different forms of epilepsy who
are also at high risk. The National Sentinel Clinical Audit of Epilepsy-Related Deaths,
however, concluded that poor epilepsy management has resulted in a
substantial number of potentially avoidable epilepsy-related deaths. To
achieve the better standards for epilepsy care set out in the NICE guidance,
immediate inward investment by the government is needed, to increase
the number of epilepsy nurses and neurologists in the UK.'