Abstract
Abstract Background The correlation between Brugada syndrome (BrS) and epilepsy has been previously reported. Sudden death (SD) is a manifestation of BrS due to malignant ventricular arrhythmias (VA), but may occur also in patients with epilepsy. Whether seizure is an uncommon event in BrS, or certain genetic variants are responsible for both seizure and arrhythmia in a subset of patients with BrS, is still to be clarified. Purpose To evaluate the comorbidity with epilepsy in a large cohort of patients with BrS at a referral center. Methods We retrospectively screened a large cohort of patients with BrS (n=238) in regular follow-up at a third-level center for arrhythmia management. Patients who previously received a diagnosis of epilepsy were enrolled. Patients with epilepsy (BrS/E+) were compared with a control group of consecutive patients without epilepsy (BrS/E-) matched for sex and age. The study endpoints were: 1) prevalence of epilepsy; 2) comparison between BrS/E+ and BrS/E- phenotypes, and assessment of VA incidence by 8-year follow-up. Results Of 238 BrS patients, 13 (5%) had a pre-existing diagnosis of epilepsy. Tonic-clonic seizures were present in 9/13, absence seizures in 3/13, and both in 1/13. Among BrS/E+ patients (median age 52 years, IQR 37-67, 80% males) 69% had spontaneous type 1 ECG pattern (9/13), and 46% presented with syncope (6/13), of which 50% arrhythmia-related (3/6). Electrophysiological study was performed in 8 BrS/E+ patients, and tested positive for sustained ventricular tachycardia/fibrillation in 50%. ICD was implanted in 61% (8/13), all in primary prevention. As compared with the matched control group (n=13), there were no differences in terms of ECG pattern, syncope, and ICD implantation rate (p>0.050). However, BrS/E+ had a positive trend for familiarity for SD (5/13 vs. 1/13, p=0.063), and more frequently experienced VA during follow-up (4/13 vs. 0/13, p=0.030). Conclusion Our retrospective analysis revealed a prevalence of 5% of epilepsy among a large cohort of BrS patients. Epilepsy was associated with a higher frequency of VA events during follow-up.
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