Preventive measures for sudden cardiac death in epilepsy beyond therapies

Abstract

We read with interest a very comprehensive review article entitled “The Mystery of Sudden Death: Mechanisms for Risks” by Lathers and colleagues [ [1] Lathers C.M. Schraeder P.L. Bungo M.W. The mystery of sudden death: mechanisms for risks. Epilepsy Behav. 2008; 12: 3-24 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar ] published in the January issue of Epilepsy & Behavior. Given the dearth of published data on potential preventive measures to minimize the risk of sudden unexpected death in epilepsy (SUDEP), we applaud Dr. Lathers and her colleagues for pursuing this topic, but we also find it necessary to address some purposes regarding their suggestions. Although the availability of pharmacological treatment of the epilepsies has expanded, antiepileptic drugs are still limited in clinical efficacy. Several factors (genetic, environmental, and social) can contribute to the inefficacy of therapy in people with epilepsy. Among these factors, nutritional aspects such as omega-3 fatty acid deficiency may have an interesting role. Substantial evidence from epidemiological and case–control studies indicates that omega-3 reduces the risk of cardiovascular mortality, particularly sudden cardiac death [ [2] Calder P.C. n-3 fatty acids and cardiovascular disease: evidence explained and mechanisms explored. Clin Sci. 2004; 107: 1-11 Crossref PubMed Scopus (447) Google Scholar ]. Following this reasoning, as omega-3 fatty acids per se have been shown to reduce cardiac arrhythmias and sudden cardiac deaths, it was hypothesized that omega-3 fatty acid supplementation in patients with refractory seizures may reduce seizures and seizure-associated cardiac arrhythmias and, hence, SUDEP [ [3] Yuen A.W. Sander J.W. Fluegel D. et al. Omega-3 fatty acid supplementation in patients with chronic epilepsy: a randomized trial. Epilepsy Behav. 2005; 7: 253-258 Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar ]. With respect to the cardioprotective effects of omega-3, it has long been believed that daily intake of 3000 to 4000 mg of fish oil supplements or two or three servings of fatty fish per week is safe and effective in adults in general, including those with neurological diseases [ [4] Mazza M. Pomponi M. Janiri L. Bria P. Mazza S. Omega-3 fatty acids and antioxidants in neurological and psychiatric diseases: an overview. Prog Neuropsychopharmacol Biol Psychiatry. 2007; 31: 12-26 Crossref PubMed Scopus (240) Google Scholar ]. It is very important, however, to emphasize that nutritional therapy (including omega-3 supplementation) is not a substitute for anticonvulsant medications.