Epilepsy Treatment in Patients with Heart Disease

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.

Automated summary

This review discusses the treatment of seizures in patients with cardiac disease, focusing on the impacts upon the native disease and drug interactions. Evidence suggests that enzyme-inducing anti-seizure medications (EIASMs) increase the risk of cardiovascular disease. The potential risk of arrhythmia in lamotrigine-treated patients with underlying cardiac disease has been highlighted, but data to support this concern is limited.