Postictal increase in T-wave alternans after generalized tonic-clonic seizures

PURPOSE: Sudden unexpected death in epilepsy (SUDEP) occurs most frequently in people with chronic uncontrolled epilepsy. Tonic-clonic seizures are a well-recognized risk factor for SUDEP. T-wave alternans (TWA) is a novel independent marker of risk of sudden cardiac death and cardiovascular mortality. The aim of this study was to determine if the level of TWA in patients with epilepsy differed after complex-partial and secondary generalized tonic-clonic seizures (sGTCS). METHODS: Electrocardiography (ECG) and electroencephalography (EEG) data from patients with drug-resistant focal epilepsy who had both complex partial and sGTCS during video-EEG telemetry were retrospectively reviewed. Periictal TWA, heart rate (HR), and heart rate variability (HRV) were analyzed. KEY FINDINGS: ECG and EEG data of 16 patients (31.6 ± 8.7 years, nine male) with focal epilepsies were analyzed. sGTCS led to a postictal increase in TWA for 15 min as well as a higher postictal HR and decreased postictal HRV for the whole observation time of 30 min. There was no significant association between postictal TWA or HR and seizure duration or duration of the tonic-clonic phase. SIGNIFICANCE: Our study demonstrates that derangements in autonomic function and TWA are highly prevalent after sGTCS in patients with chronic uncontrolled epilepsy. Further studies are warranted to investigate the value of TWA for risk stratification in epilepsy patients for sudden cardiac death and SUDEP.