[Research] 2 studies show risk of SUDEP with Lamotrigene

[Rae1889]

This Lamotrigene study is pretty interesting, and was just wondering everyones thoughts on it?

 

[Nakamova]

This raises a lot of questions. I suggests that Lamictal might affect cardiac function, and that that might play a role in SUDEP. IF more women are using Lamictal (because of its safety record in pregnancy), and IF Lamictal has cardiac side effects, THEN women may be more vulnerable to cardiac-related SUDEP (especially since women are much more likely than men to die from a first heart attack).

I hope there are ongoing studies of how Lamictal affects heart function (not too mention how Lamictal affects vision), but since they still don't even know how Lamictal works to prevent seizures, I'm not optimistic...

The second study mentioned in the article only consisted of 26 patients, so it mostly indicates the need for more data.

 

[Rae1889]

I agree. although from what I have been told, women die more often from a first heart attack because medical community doesnt take their symptoms seriously, and women have a higher pain tolerance (due to having ot be pregnant) so they mainly dismiss their symptoms.

Also, womens heart attack symptoms are not the usual ones you see with men. Instead of left arm numbness and chest pain, women often get left jaw numbness and back pain.

 

[msuder0583]

i just LOVE how these studies prove all these bad things about meds that i'm on. always makes me feel good......

 

[Endless]

I think a thorough heart workup should be part of the epilepsy diagnosis process. There are so many heart-related diseases that mimic seizures. The bonus in that heart workup is by the end of it, the person in question knows what kind of shape their heart is in. That doesn't answer how lamictal affects it, however.

Answers. We want answers. It wouldn't pay for the drug companies to research the effects on the heart, so who would fund the study? I guess that just the data from the fda would have to be used, and that's not much.

 

[Endless]

Well, here I was feeling great about having a good heart, thinking that an identifiable problem with the heart was what they were talking about as a major cause of SUDEP. It might be one of the causes, but the article below implies that it is the seizure's effect on the heart, including from autonomic seizures, that are a cause SUDEP.

Heart rate variability

Heart rate variability (HRV) during a seizure can be calculated from ECG recorded simultaneously with EEG. HRV before, during, and after the seizure can be an indicator of the sum of sympathetic and parasympathetic input to the heart. Novak et al documented rapid parasympathetic withdrawal approximately 30 seconds before seizure onset and a sympathetic activation peak at seizure onset (Novak, 1999).

In a group of patients with secondarily generalized CP seizures, Delamont et al reported an increase in parasympathetic activity before the seizure to above normal values, and a significant fall to previously established normal values following the seizure (Delamont et al, 1999). They proposed that pre-ictal elevation of cardiac parasympathetic activity may be a marker for secondary generalization of seizures. Al-Aweel et al evaluated HRV in frequency domain and demonstrated an increase in immediate postictal low-frequency oscillations (Al-Aweel et al, 1999). This is yet another indicator of postictal autonomic instability.

In a recent study, Boro evaluated the changes in HRV before and after cps (Boro, 2005). These preliminary data suggest that increased sympathetic and decreased vagal HR modulation often precede the electroclinical onset and ictus of TL seizures. The postictal period is characterized by decreased vagal HR modulation that persists for considerably longer after secondarily generalized seizures.

Decreased HRV is known to increase the vulnerability of cardioregulatory centers, leading to an increase in ventricular automaticity, and potentially to arrhythmia (see Mechanism below).

http://www.emedicine.com/NEURO/topic658.htm

If I read the article correctly, seizures (especially autonomic seizures) effect the heart and cause arrythmia, which can cause SUDEP.

 

[alivenwell]

If I read this right, if Lamictal completely controls seizures, then there is no threat to one's heart rhythm.

I do know an irregular heart can cause a lot of other damage to other organs.

In general, it indicates seizures alone can potentially create irregular heart rate rhythm. Does that imply we should get pacemakers?!

 

[Cint]

I hope there are ongoing studies of how Lamictal affects heart function (not too mention how Lamictal affects vision), but since they still don't even know how Lamictal works to prevent seizures..............................................

The second study mentioned in the article only consisted of 26 patients, so it mostly indicates the need for more data.

Like most drug studies, they are based on a limited amount of patients, therefore we don't get the "whole" story until years later. Sometimes the drugs are put on the market too soon, thanks to the greedy little pharmaceutical companies, and their drugs can make some of us worse off than before we even took their drugs.

I posted just the other day about my meeting a woman in Starbucks who had lost her daughter two years ago to SUDEP. The girl was 17 years old and was suddenly taken in the night, without any kind of warning. The parents had never heard of SUDEP. So heartbreaking.

Here is her website where you can read her story:
http://www.chelseahutchisonfoundation.org/?q=chelsea