Sudden unexpected death in epilepsy (SUDEP) is an important cause of mortality in patients with epilepsy. Potential mechanisms include respiratory dysregulation, arousal impairments, autonomic dysfunction, ictal or postictal arrhythmia, and neurogenic cardiopulmonary dysfunction. Pacemaker implantation has been proposed as an intervention that may lessen the risk of SUDEP among patients with ictal asystole [1]. However, the efficacy of this intervention is unclear, and the relationship between ictal asystole and SUDEP is unknown.
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