Epilepsy–heart syndrome: Concept, clinical context, and opportunity for integrated care

In this concept paper, we introduce epilepsy-heart syndrome as a shared burden of illness between epilepsy and cardiac disorders. This pragmatic definition is agnostic of which condition came first (the epilepsy or the cardiac disorder), recognising that these conditions can each serve as a risk factor for the other owing to a bidirectional relationship that exists between the brain and the heart. To provide clinical context, we include ictal asystole as an example phenotype of epilepsy-heart syndrome. We highlight evidence of patients with ictal asystole coming to harm owing to the failure of integrated care between neurology and cardiology. This underscores epilepsy-heart syndrome as an unmet need for collaborative care between neurology and cardiology. To address this, we propose a framework for integrated care, drawing upon our own centre's recently established and successful multidisciplinary team meeting (MDT) between neurologists and cardiologists, our joint cardiology-neurology PhD programme, and our work developing a joint national guideline on ictal asystole management between the Association of British Neurologists (ABN) and the British Heart Rhythm Society (BHRS).