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Benjamin H. Natelson, MD; Ronald V. Suarez, MD; Christopher F. Terrence, MD; Rosa Turizo, MD

Arch Neurol. 1998;55:857-860.

Background  Approximately 1 in 1000 patients with epilepsy dies suddenly and unexpectedly with no obvious medical cause. The purpose of this study was to determine if the hearts of such individuals harbor occult cardiac pathology.

Design  Following a comprehensive protocol, we performed careful pathologic evaluations of the hearts of 7 patients with epilepsy who died suddenly and 13 previously healthy people who died by hanging or a drug overdose. Hearts were studied only when there was no history or gross anatomical evidence of heart disease or the use of adrenergic drugs.

Methods  Multiple sections of each heart were evaluated independently by 2 cardiac pathologists who were blinded to patient group.

Results  Pathologic conditions were found in 5 hearts in the group with epilepsy and in none of the hearts in the comparison group. Four of the 7 hearts in the group with epilepsy had evidence of irreversible pathology in the form of perivascular and interstitial fibrosis. 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 cardiac pathologic conditions that may be responsible for their deaths.

From the Department of Neurosciences, New Jersey Medical School, Newark (Drs Natelson, Suarez, and Terrence); the Neurology Service, Veterans Affairs Medical Center, East Orange (Drs Natelson and Terrence); and Morris County Medical Examiner's Office, Morristown (Drs Suarez and Turizo), NJ. Dr Turizo participated in this work while on sabbatical from the Department of Pathology, University of Antioquia, Medellin, Colombia.

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