EEG and ECG in sudden unexplained death in epilepsy

Epilepsia. 2004 Apr;45(4):338-45. doi: 10.1111/j.0013-9580.2004.05503.x.


Purpose: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality for patients with epilepsy. Cardiac factors may be involved and were evaluated in this study.

Methods: EEG and ECG data for 21 patients with definite (n = 6) or probable (n = 15) SUDEP were compared with data from a group of 43 patients with refractory partial epilepsy. ECG abnormalities and heart rate (HR) changes were correlated with clinical data.

Results: Fourteen patients died in their sleep; two were awake. Ictal maximal HR (90 seizures from 16 of 21 patients) was significantly higher in SUDEP (mean, 149 beats/min, BPM) than in comparison patients (mean, 126 BPM; p < 0.001). Greater increases in HR were associated with seizures arising from sleep (78 BPM increase) than from wakefulness (47 BPM; p < 0.001) in SUDEP, as compared with the non-SUDEP group (52 BPM in sleep, 43 BPM in wakefulness; p = 0.27). Ictal cardiac repolarization and rhythm abnormalities occurred in 56% of SUDEP (including two atrial fibrillation, two ventricular premature depolarizations, two marked sinus arrhythmia, two atrial premature depolarizations, one junctional escape, one ST-segment elevation), and 39% of comparison patients (p = 0.39). No specific seizure onset (laterality or lobe) was associated with SUDEP.

Conclusions: This study reveals, for the first time, evidence of increased autonomic stimulation (as measured by HR) associated with seizures, particularly in sleep, in patients with SUDEP, as compared with a clinically similar group of patients with refractory epilepsy.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Chi-Square Distribution
  • Cluster Analysis
  • Death, Sudden* / epidemiology
  • Electrocardiography* / methods
  • Electrocardiography* / statistics & numerical data
  • Electroencephalography* / methods
  • Electroencephalography* / statistics & numerical data
  • Epilepsy / epidemiology
  • Epilepsy / physiopathology*
  • Epilepsy / surgery
  • Female
  • Heart Rate
  • Humans
  • Male
  • Middle Aged