Treatment of Epilepsy in Patients with Cardiovascular Disease

Abstract Purpose of Review To review the complex bidirectional relationship between epilepsy and cardiovascular disease (CVD), focusing on shared risk factors, cardiovascular morbidity and mortality in people with epilepsy (PWE), the cardiac effects and interactions of antiseizure medications (ASMs), and management considerations in patients with coexisting cardiac conditions. Recent findings Recent large-scale studies demonstrate that PWE have approximately double the cardiovascular mortality of the general population, largely driven by modifiable factors such as hypertension, diabetes, and associated lifestyle factors. Enzyme-inducing ASMs (carbamazepine, phenytoin, phenobarbital) increase dyslipidemia and reduce statin efficacy, while sodium channel blockers can affect cardiac conduction and, in susceptible patients, increase arrhythmia risk. Valproate shows a mixed cardiovascular profile, and low dose fenfluramine appears safe with close echocardiographic surveillance. Accurate differentiation of seizure versus syncope and coordinated perioperative care to allow safe surgical and neurostimulation interventions even in patients with cardiac implantable electronic devices. Summary Epilepsy and CVD frequently coexist and share modifiable risk factors that should be targeted to reduce morbidity and mortality. Non–enzyme-inducing ASMs and cautious use of sodium-channel blockers are preferred in patients with cardiac disease. Multidisciplinary care, cardiac monitoring when indicated, and integrated neuro-cardiology collaboration are essential for optimizing outcomes in this growing patient population.