Cardiac and cerebrovascular diseases in epilepsy. Causes, associations and consequences

People with epilepsy commonly display cardiovascular risk factors which predispose to cerebrovascular diseases and vascular-linked epilepsies. Conversely, epilepsies and anticonvulsant drugs can have negative effects on cardiovascular risks. In particular, enzyme-inducing anticonvulsant drugs may cause or worsen dyslipidemia, overweight or hyperhomocysteinemia. Cardiovascular diseases may cause epilepsies and acute symptomatic seizures, e.g. by ischemic or hemorrhagic stroke, cerebral hypoxia and hypertensive crises. Cardiovascular and total mortality are both elevated in people with epilepsy. They suffer from stroke, heart attacks and sudden cardiac death more frequently and at younger ages than the general population. Epileptic seizures can lead to disturbances of coronary blood flow, heart muscle mechanics and cardiac rhythm. The cardiac stress of seizures is reflected by ECG changes and troponin increases. Cardiac arrhythmias are a frequent consequence of epileptic seizures. Ictal and postictal tachycardias are common, diagnostically useful and rarely dangerous. Ictal bradycardia and asystole can trigger usually self-limiting syncope, while postictal asystole may lead to death. Syncope is the most common differential diagnosis to epileptic seizures. Anticonvulsants and more rarely vagal nerve stimulation can have arrhythmogenic effects. Caution is advised, especially in patients with heart disease.