Epilepsy and cardiac arrhythmias: understanding and prevention of SUDEP

Abstract

This thesis focuses on two aspects of SUDEP: (1) the role of arrhythmias to understand its pathophysiology and (2) the role of supervision to potentially improve preventative measures. In chapter two, the focus is on all possible mechanisms of association between

epilepsy and cardiovascular conditions. In chapter three, a systematic literature search is described to determine the full spectrum of all cardiac arrhythmias to occur during or after epileptic seizures, with special attention to the timing of arrhythmias (ictal versus postictal) as this seems crucial to understand its relation to SUDEP. In chapter four, the conflicting reports on long-term ECG recordings in epilepsy and the potential of postictal arrhythmias as a SUDEP biomarker is addressed by reporting a large-scale multi-centre trial. To evaluate the potentially protective role of nocturnal supervision I will present the results of an audit at a residential department in chapter five. In this study I assess the impact of continuous video monitoring on the detection of nocturnal seizures. Chapter 6 describes a SUDEP case control study. In this study I ascertain the effects of nocturnal seizures and nocturnal supervision on SUDEP risk in a cohort of people with epilepsy living in residential care.