Intersection of epilepsy and cardiac health: Insights from electrocardiography and syndromic associations

Epilepsy is a chronic neurological condition marked by recurrent, uncontrolled seizures. Identifying comorbidities in epilepsy is critical for preventing mortality. Among these, the autonomic nervous system's role in epilepsy often manifests as cardiac disorders. Patients with epilepsy (PWE), particularly those with poorly controlled seizures, have a higher prevalence of cardiac pathologies compared to the general population. Investigating the connection between seizures and cardiac deaths is crucial for addressing seizure-related cardiac complications. Notably, 80% of individuals with epilepsy exhibit cardiovascular comorbidities, supporting the concept of the "epileptic heart." Electrocardiography (ECG), a noninvasive tool for recording heart electrical activity, is valuable for detecting cardiac abnormalities in epilepsy. Its use can aid in diagnosing and assessing the severity of cardiovascular conditions. This review highlights the importance of cardiac evaluation through ECG monitoring, even in PWE who have well-controlled seizures. By addressing epilepsy-related cardiac dysfunctions, it examines relevant ECG findings reported in the literature and emphasizes the role of ECG in routine epilepsy management, particularly in the context of preventing sudden cardiac death and sudden unexpected death in epilepsy.