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Sudden Unexpected Death in Epilepsy – Closer to an Answer?

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Natural remedies for seizures
SUDEP answers

Among epilepsy sufferers, one of the greatest fears is SUDEP – sudden unexplained death in epilepsy.

Maybe this is because it seems like we don’t know why it happens. Maybe it’s because it seems to happen for no reason.

SUDEP is a very real concern for people with epilepsy. People with epilepsy are at an increased risk of dying when compared to the general population who do not have seizures. Some of this increase risk is from obvious causes like drowning and motor vehicle accidents as a direct result of things that happen during a seizure.

But other deaths are not quite as clear cut. For this reason researchers are constantly searching for answers. High on the list of potential suspects is cardiac rhythm abnormalities. This particular study attempts to clarify the links between sudden cardiac arrest and epilepsy. Specifically, ventricular tachycardia and fibrillation (VT/VF) were identified. V-fib is a condition where the heart is beating out of sync. As a result, blood cannot be efficiently pumped through the heart. This is a life-threatening condition.

Ventricular tachycardia is a condition where the ventricles of the heart are beating at too fast of a rate. While not as life-threatening as V-fib, it is a sign that something is seriously wrong with the ability to control the rate that the heart is beating.

With this in mind, the researchers looked at 3 groups of participants:

  1. 18 people with active epilepsy as well as ECG-confirmed VT/VF.
  2. 470 individuals with VT/VF without epilepsy
  3. 54 individuals with epilepsy but without identified without VT/VF

These groups of individuals were then compared to see how

Here’s what they found:

  • In the group of 18 epileptics with VT/VF, 10 had an obvious cardiac cause for the heart rhythm problems and 5 had a presumed cardiovascular cause.
  • In 2 of the remaining 3 epileptics with VT/VF, near–sudden unexpected death in epilepsy (SUDEP) was established after successful resuscitation.
  • In these two, there was a higher prevalence of congenital/inherited heart disease (17% vs 1%), and they experienced VT/VF at younger age (57 vs 64 years) than VT/VF individuals without epilepsy.

Based on this, the authors concluded that the heart rhythm abnormalities that occurred in epileptic patients was a result of underlying cardiovascular disease rather than something related to the epilepsy. In other words, a “comorbidity,” or two conditions occurring at the same time but not necessarily related.

Here’s my take…

For some reason, we have been very, very, very slow to adopt what the research has been saying for decades now—that epilepsy is, at it’s root, a problem with the mitochondria in the brain cells. Due to a long list of potential problems and damage that occurs to the mitochondria, the brain cells are no longer able to function in a normal manner.

This lack of energy leads to brain cells firing before they are supposed to fire, creating a seizure. This is a concept that we dance around in treatment while never really addressing. Sadly, medications do not fix this aspect of epilepsy and some even make it worse.

Here’s the rub. The way that brain cells regulate their firing is the exact same way that the heart regulates its rhythm. It makes absolute complete sense that there is a potential for sudden cardiac death in persons with epilepsy, leading to SUDEP.

This study also highlights an additional underlying concern; epileptics need to focus on leading a brain-healthy lifestyle. This same lifestyle is inherently protective against heart disease. And yet, in this study, it seems like the participants with epilepsy actually had worse cardiovascular health than their non-epileptic counterparts.

Not good.

Sudden Unexplained Death in Epilepsy: Lower Your Risk

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While just dealing with seizures is bad enough, the mind of every epileptic there looms the fear of sudden unexplained death in epilepsy, also known as SUDEP.

The exact cause of SUDEP has not been identified, although cardiac problems are very high on the list of likely suspects.

This should not come as a surprise since, at the cellular level, the way our heart cell develops the rhythm of our heartbeat is similar to the way our brain cells fire.  It all has to do with boring topics like cellular membrane potential and voltage gated channels.  (I usually save these topics for blogs focusing on insomnia…)

There are risk factors for sudden unexplained death in epilepsy that we already know and understand.  Some risk factors, such as living alone will increase the risk of SUDEP.  Some studies have suggested that the anti-epileptic drugs themselves affect heart rhythm and increase the risk of SUDEP.

Obviously, doing everything you can to improve brain health in epilepsy should be the most important factor in management of seizures.  Without appropriate lifestyle changes targeted towards brain health, even seizures successfully controlled with medication are missing the real problem.

Chronic epilepsy and seizures are the result of something being wrong in the brain.  Most evidence points to the mitochondria and the ability of brain cells to generate the energy they need to function properly as causative in seizures.

Overall, because of this, SUDEP is a valid concern, but the incidence still remains low.  The progression of damage to the brain, however, is occurring in every epileptic.  This is why the concern should be on brain health rather than concern over sudden unexplained death.

Should you STILL be worried, this particular study provides some additional help.

Get a pet.

Yup.  It can be that simple.  Researchers looked at the rate of SUDEP in a group of 1092 epileptics and looked at those who had succumbed to SUDEP.  1% (11) were classified as SUDEP.  Not a single one of these were pet owners.

On the other hand, in the remaining epileptics, 61% were-pet owners.

While this is not conclusive by any means, it fits with what we’ve seen in other studies on the heart protection that occurs with pet owners who have chronic conditions.

As an avid dog lover, it would seem a simple tool to add to the toolbox of improving your brain health and improving your chances of a long and healthy life.

What  have you done to help heal your brain today?