Cardiac deaths in epilepsy

A study of heart disease mortality and morbidity in patients with epilepsy in Rochester, Minnesota, U.S.A., is presented. In a cohort of 725 incident cases of epilepsy followed for approximately 10,000 person-years, 237 deaths and 48 incident cases of ischemic heart disease were noted. Overall, the cohort mortality rate was 2.1 times that of the general population. For those with idiopathic epilepsy, the mortality rate was 1.6 times that of the general population. For ischemic heart disease, the epilepsy cohort experienced a standardized mortality rate (SMR) of 1.6, slightly higher for remote symptomatic than idiopathic epilepsy. For sudden death as the initial manifestation of heart disease, the SMR was 2.3. The ratio was not significantly higher for those with idiopathic epilepsy but was 3.9 for remote symptomatic epilepsy. The findings show much lower incidence rates and relative incidence of sudden death than all of the more recent sudden unexpected death in epilepsy studies. Reasons for this discrepancy are discussed.