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Epilepsy Treatment in Patients with Heart Disease

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Abstract

Purpose of review

This review highlights issues pertaining to the treatment of seizures in patients with cardiac disease. These fall into two categories: impacts upon the native disease — primarily an issue with coronary artery disease and arrhythmia — and drug interactions, which are important in all types of cardiac disease.

Recent findings

A sizeable body of evidence indicates that enzyme-inducing anti-seizure medications (EIASMs) increase serum lipids and other serological and surrogate markers of vascular risk. A recent large epidemiologic study confirmed that patients treated with EIASMs are at significantly increased risk for cardiovascular disease. A recent Food and Drug Administration (FDA) alert highlighted the potential risk of arrhythmia in lamotrigine-treated patients with underlying cardiac disease; however, subsequent investigations have yielded, at best, only modest support for this concern.

Summary

EIASMs are poor choices for patients with cardiac disease due to their propensity to cause drug interactions, and the multiple lines of evidence suggest that they exacerbate coronary artery disease. The FDA and epilepsy societies have recently highlighted the potential for exacerbation of arrhythmia with the use of lamotrigine; however, data to support this appears marginal, and more work is needed.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, 908 Walnut Street, 2nd Floor, Philadelphia, PA, 19107, USA

    Scott Mintzer MD

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  1. Scott Mintzer MD
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Correspondence to Scott Mintzer MD.

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Mintzer, S. Epilepsy Treatment in Patients with Heart Disease. Curr Treat Options Neurol 25, 429–436 (2023). https://doi.org/10.1007/s11940-023-00774-3

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  • DOI: https://doi.org/10.1007/s11940-023-00774-3

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