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To the Editor:
Myocardial ischemia and arrhythmia are possible pathomechanisms for sudden unexplained death in epilepsy (SUDEP). To assess cardiovascular abnormalities in 23 patients with refractory epilepsy, Tigaran et al. performed noninvasive investigations (12-lead resting ECG, Holter monitoring, echocardiography, ergometric exercise test, myocardial scintigraphy), and, if abnormalities were found, coronary angiography.1 During video-EEG monitoring 125 seizures occurred. Holter monitoring found that 40% (9/22) of patients had ST-segment depression during (n = 1) or just after a seizure (n = 8).
The interpretation of the findings that cardiac abnormalities during or after seizures potentially explain SUDEP raises several questions:
1) ST-segment depression during Holter monitoring with the used criterion (≥0.10 mV) is a rather unspecific finding, occurring in 11% of healthy men. …
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