The Brain & The Heart
Cardiac and neurologic disorders can share a number of common symptoms, such as dizziness, fainting, and abnormal body movements. Furthermore, heart health should be a concern to neurologists due to cerebral emboli1, or for epileptologists specifically, differentiating epileptic from syncopal episodes2. Recent research indicates an increased rate of cardiovascular comorbidities in patients with epilepsy as high as 62-82%.3 In patients suffering from chronic epilepsy, the damage that recurrent seizures may inflict on the heart has also started to receive direct attention, leading to the concept of the “Epileptic Heart.”3, 4 Given this accumulating evidence that brain and heart health go hand in hand, it is necessary for neurologists to consider the heart when treating patients with epilepsy.
Cardiac Death & Epilepsy
The risk of sudden cardiac death (SCD) is distinct from the well-known Sudden Unexplained Death in Epilepsy Patients (SUDEP). SUDEP is a fatal and unexplained phenomenon typically impacting individuals with epilepsy between the ages of 20-40, and is potentially caused by post-ictal pulmonary failure 5. However, by definition, a SUDEP diagnosis precludes evidence of sudden cardiac death (SCD). Patients with epilepsy, nonetheless, present a unique risk for SCD, as these patients have an estimated risk three times higher than the general population6, 7. These estimates rise to a five-fold risk in patients over 50 years of age with epilepsy6, and a six-fold risk in patients with symptomatic epilepsy7 – and these risks are independent of the risk of SUDEP
A More Cohesive Approach
Although ambulatory, multiday cardiac monitoring is not currently the routine practice of neurologists and epileptologists, mounting evidence strongly suggests that comprehensive epilepsy care requires these procedures to be included.
In practice, the question becomes – when should I order concurrent cardiac monitoring, and what kind of monitoring is needed? The table below can provide guidance on when cardiac monitoring can be a suitable supplement to at home EEG.
Indications for Long-term Video EEG or Concomitant Long-term VEEG + MCT
- Suspected epilepsy
- Suspected psychogenic events
- Brain injury
- Alzheimer’s disease / dementia
- Suspected Syncope
- Recurrent episodes of non-convulsive transient loss of consciousness followed, or not followed by jerks or involuntary movements
- Identification of tachyarrhthmia, bradyarrhythmia or screening for asystole accompanying a seizure
With Stratus, our concurrent in-home video EEG and mobile cardiac monitoring are easy for patients and neurologists. Additionally, we have partnered with Heartbeat Health to offer a national cardiologist reader group to assist with diagnosis and recommended treatment plans for ordering neurologists.
About the Author
Jeremy D. Slater, MD, FAAN, FAES, FACNS is the Chief Medical Officer for Stratus. Dr. Slater has worked in the field of epilepsy for more than 27 years and has served as an investigator for numerous clinical trials and research initiatives. He served as Director of the Texas Comprehensive Epilepsy Program, one of the largest epilepsy surgery programs in the country, and currently heads up MERLN, Stratus’ R&D division.
- Oppenheimer SM, Lima J. Neurology and the heart. J Neurol Neurosurg Psychiatry. 1998;64(3):289-97. doi:10.1136/jnnp.64.3.289
- Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A, Jr., et al. ACC/AHA Guidelines for Ambulatory Electrocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). Developed in collaboration with the North American Society for Pacing and Electrophysiology. J Am Coll Cardiol. 1999;34(3):912-48. doi:10.1016/s0735-1097(99)00354-x
- Verrier RL, Pang TD, Nearing BD, Schachter SC. The Epileptic Heart: Concept and clinical evidence. Epilepsy Behav. 2020;105:106946. doi:10.1016/j.yebeh.2020.106946
- Verrier RL, Pang TD, Nearing BD, Schachter SC. Epileptic heart: A clinical syndromic approach. Epilepsia. 2021. doi:10.1111/epi.16966
- Ryvlin P, Nashef L, Lhatoo SD, Bateman LM, Bird J, Bleasel A, et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. The Lancet Neurology. 2013;12(10):966-77. doi:http://dx.doi.org/10.1016/S1474-4422(13)70214-X
- Bardai A, Lamberts RJ, Blom MT, Spanjaart AM, Berdowski J, van der Staal SR, et al. Epilepsy is a risk factor for sudden cardiac arrest in the general population. PLoS One. 2012;7(8):e42749. doi:10.1371/journal.pone.0042749
- Bardai A, Blom MT, van Noord C, Verhamme KM, Sturkenboom MC, Tan HL. Sudden cardiac death is associated both with epilepsy and with use of antiepileptic medications. Heart. 2015;101(1):17-22. doi:10.1136/heartjnl-2014-305664