Age-Specific Mechanisms of Sudden Death Associated With Epilepsy

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-09-01 DOI:10.1016/j.jacep.2025.04.028

Lauri Holmstrom MD, PhD , Audrey Uy-Evanado MD , Arayik Sargsyan MD , Harpriya Chugh BS , Habiba Aziz MS , Vinicius F. Calsavara PhD , Alex A.T. Bui PhD , Angelo Salvucci MD , Jonathan Jui MD , Kyndaron Reinier PhD , Lisa M. Bateman MD , Sumeet S. Chugh MD

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引用次数: 0

Abstract

Background

Epilepsy is associated with an increased risk of sudden cardiac death (SCD), which can occur at any age. Due to low numbers of SCD events in longitudinal cohort studies of epilepsy, studies of age-specific clinical profiles have not been performed.

Objectives

In this study, the authors investigated the detailed clinical characteristics of SCD associated with epilepsy in the general population, across all ages.

Methods

Individuals with a pre-SCD diagnosis of epilepsy were identified from all out-of-hospital SCD cases prospectively ascertained in Portland, Oregon since 2002 (catchment population ∼1 million) and Ventura County, California since 2015 (catchment population ∼850,000). Lifetime clinical records were evaluated for a detailed assessment of the clinical profile.

Results

From a total of 8,287 SCD cases, we identified 356 (4.3%) with a pre-SCD history of epilepsy. The proportion of previously diagnosed epilepsy in overall SCD cases was highest among younger subjects and progressively decreased with age (from 35.3% in 1 to 10 years to 2.5% in >80 years) (P < 0.001). There was a distinct shift in the clinical profile demarcated by the 50 to 60 years decade: Younger subjects had the highest prevalence of drug-resistant epilepsy and prearrest seizures (P < 0.001). Older subjects had a significantly higher prevalence of stroke and mood disorders, and these differences were specific for SCD in epilepsy (P < 0.001).

Conclusions

There were significant clinical profile differences by age among individuals with epilepsy, which were observed to be specific for SCD. Age-specific mechanisms should facilitate the development of targeted prevention strategies for SCD in epilepsy.

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癫痫相关猝死的年龄特异性机制

背景：癫痫与心源性猝死（SCD）风险增加相关，可发生在任何年龄。由于癫痫纵向队列研究中SCD事件的数量较少，因此尚未进行针对特定年龄的临床概况的研究。目的：在这项研究中，作者调查了所有年龄段的普通人群中与癫痫相关的SCD的详细临床特征。方法：从2002年以来在俄勒冈州波特兰市（流域人口约100万）和2015年以来在加利福尼亚州文图拉县（流域人口约85万）前瞻性确定的所有院外SCD病例中确定患有SCD前癫痫诊断的个体。终身临床记录进行评估，以详细评估临床概况。结果：在总共8287例SCD病例中，我们发现356例（4.3%）有SCD前癫痫史。在所有SCD病例中，既往诊断癫痫的比例在年轻受试者中最高，并随着年龄的增长而逐渐下降（从1 ~ 10岁的35.3%降至80岁的2.5%）（P < 0.001）。50 - 60岁年龄组的临床特征发生了明显的变化：年轻受试者的耐药癫痫和骤停前发作的患病率最高（P < 0.001）。老年受试者的中风和情绪障碍患病率明显更高，这些差异是癫痫SCD特有的（P < 0.001）。结论：不同年龄的癫痫患者的临床特征存在显著差异，这是SCD所特有的。年龄特异性机制应有助于制定针对性的癫痫SCD预防策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.