Effects of Seizures on Cardiac Function (original) (raw)
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Cardiac Arrhythmias and Sudden Unexpected Death in Epilepsy (SUDEP)
Pacing and Clinical Electrophysiology, 2011
Sudden unexpected death in epilepsy (SUDEP) is a major clinical problem in epilepsy patients in the United States, especially those with chronic, uncontrolled epilepsy. Several pathophysiological events contributing to SUDEP include cardiac arrhythmias, respiratory dysfunction, and dysregulation of systemic or cerebral circulation. There is a significant body of literature suggesting the prominent role of cardiac arrhythmias in the pathogenesis of SUDEP. There is evidence to say that long‐standing epilepsy can cause physiological and anatomical autonomic instability resulting in life‐threatening arrhythmias. Tachyarrhythmias, bradyarrhythmias, and asystole are commonly seen during ictal, interictal, and postictal phase in epilepsy patients. It is unclear if these rhythm disturbances need attention as some of them may be just benign findings. Evidence regarding prolonged cardiovascular monitoring or the benefit of pacemaker/defibrillator implantation for primary or secondary preventi...
Sudden cardiac death in epilepsy disappoints, but epileptologists keep faith
Arquivos de Neuro-Psiquiatria, 2016
Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP.
2009
Seizures frequently affect the heart rate and rhythm. In most cases, seizure-related cardiac changes are transient and do not appear to cause clinically significant abnormalities for the patient. Great interest in this area of research has been generated because of a possible connection with sudden unexpected death in epilepsy (SUDEP). While there are clear, but rare complications from seizure-related cardiac arrhythmias, such as ictal asystole that causes syncope, the overall risk of seizures on cardiac status and any potential connection between seizures and SUDEP still remain uncertain.
Heart rate and blood pressure in sudden unexpected death in epilepsy (SUDEP)
Epilepsy research, 2016
Epilepsy is associated with interictal and ictal autonomic dysfunction. Seizures can immediately cause increases in blood pressure (BP) and heart rate (HR). However, it is unknown whether uncontrolled seizures, particularly when frequent, might chronically elevate the BP or HR. Additionally, it is unknown whether the interictal BP and HR is altered in individuals who are at risk for SUDEP, compared with other individuals with epilepsy. SUDEP often occurs in patients with highly refractory epilepsy. Such individuals might be at risk for a state of chronically heightened sympathetic tone, which might affect the HR and BP interictally. This study compared the resting awake interictal HR and BP in individuals who subsequently died due to SUDEP and compared these to HR and BP in two control epilepsy groups (refractory and controlled). While the overall HR and BP are similar between groups, there is a trend toward a higher diastolic BP and more stable HR in individuals who subsequently di...
The Epileptic Heart: Concept and clinical evidence
Epilepsy & Behavior, 2020
Sudden unexpected death in epilepsy (SUDEP) is generally considered to result from a seizure, typically convulsive and usually but not always occurring during sleep, followed by a sequence of events in the postictal period starting with respiratory distress and progressing to eventual cardiac asystole and death. Yet, recent communitybased studies indicate a 3-fold greater incidence of sudden cardiac death in patients with chronic epilepsy than in the general population, and that in 66% of cases, the cardiac arrest occurred during routine daily activity and without a temporal relationship with a typical seizure. To distinguish a primarily cardiac cause of death in patients with epilepsy from the above description of SUDEP, we propose the concept of the "Epileptic Heart" as "a heart and coronary vasculature damaged by chronic epilepsy as a result of repeated surges in catecholamines and hypoxemia leading to electrical and mechanical dysfunction." This review starts with an overview of the pathophysiological and other lines of evidence supporting the biological plausibility of the Epileptic Heart, followed by a description of tools that have been used to generate new electrocardiogram (EKG)-derived data in patients with epilepsy that strongly support the Epileptic Heart concept and its propensity to cause sudden cardiac death in patients with epilepsy independent of an immediately preceding seizure.
Epilepsia, 2010
Purpose: To determine whether abnormal cardiac repolarization and other electrocardiography (ECG) predictors for cardiac mortality occur in epilepsy patients and whether they are associated with an increased risk for sudden unexpected death in epilepsy (SUDEP). Methods: In a matched-pair case-control study, recordings of adult patients with pharmacoresistant focal epilepsies who died from SUDEP and who had previously had presurgical video-EEG (electroencephalography) telemetry were reviewed. Living controls were matched for age, gender, and date of admission for video-EEG telemetry. Periictal heart rate (HR), corrected QT interval (QTc), postictal HR recovery, HR variability, and cardiac rhythm were assessed. QT dispersion was analyzed with 12-lead ECG. Results: A total of 38 patients (19 per group) had 91 recorded seizures. QTc was prolonged above pathologic upper limits in 9 of 89 seizures and 5 of 38 patients. Nine of 34 patients displayed patho-logic QT dispersion. Presence of neither pathologic cardiac repolarization nor other ECG features were specifically associated with SUDEP. SUDEP patients were, however, more likely to lack pathologic cerebral magnetic resonance imaging (MRI) findings, less likely to experience antiepileptic drug reduction during telemetry, and had more secondarily generalized tonic-clonic seizures (SGTCS) per year. Discussion: Our study did not reveal a clear-cut ECG predictor for SUDEP. Pathologic cardiac repolarization is not uncommon in adult patients with pharmacoresistant focal epilepsy and could favor occurrence of fatal tachyarrhythmia as one plausible cause for SUDEP. SGTCS are a risk factor for SUDEP, have, as compared to complexpartial seizures, a greater, unfavorable impact on heart activity, and may thereby additionally compromise cardiac function.
CARDIAC AUTONOMIC DYSFUNCTION IN PATIENTS WITH EPILEPSY
International Journal of Pharmacy and Pharmaceutical Sciences, 2023
Objective: The objective of this research was to appraise autonomic impairment through the examination of both time-domain and frequencydomain parameters of heart rate variability in individuals with epilepsy. Methods: Thirty epilepsy patients and thirty healthy subjects were enrolled in our study for evaluation of autonomic functions, which was assessed by comparing heart rate variability between epilepsy patients and healthy subjects. Results: There was no notable disparity observed in mean heart rate between the two groups. However, the frequency-domain metrics-LF Power, HF Power, and LF/HF ratio exhibited statistically noteworthy differences when comparing the patients to the control group (p-value<0.05). Conversely, parameters such as SDNN, RMSST, and pNN50 did not demonstrate statistically considerable differences in comparison to the controls (p-value>0.05). The parameters did not exhibit statistically significant distinctions between individuals with epilepsy for under 10 y and those diagnosed with epilepsy for over 10 y. Conclusion: Our investigation revealed a notable contrast in HRV metrics between the patient group and the group of individuals in good h ealth. The potential utilization of HRV as an indicator of susceptibility to SUDEP could enhance the quality of guidance provided to both patients and their families. Additional exploration is warranted, involving more extensive participant cohorts, and examining the impact of anti epileptic medications on HRV, within future studies.
The brain-heart connection: implications for understanding sudden unexpected death in epilepsy
Cardiology Journal, 2009
Epilepsy is one of the commonest neurological problems worldwide. Approximately 3% of the general population will suffer from epilepsy at some point in their lives. Unfortunately, individuals with epilepsy are at a higher risk of death than the general population, and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Information concerning risk factors for SUDEP is conflicting, but potential risk factors include young age, early onset of epilepsy, duration of epilepsy, uncontrolled seizures, seizure frequency, antiepileptic drug number and winter temperatures. Although the cause of SUDEP is still unknown, its most commonly suggested mechanisms are cardiac abnormalities during and between seizures. As the anatomical substrate of epileptic activity in the central nervous system shows a direct relation to cardiovascular alterations, this may suggest that patients with epilepsy associated with focal central nervous system lesions may face a particular risk of SUDEP. Currently, experimental and clinical data supports the importance of specific brain structures in the behavioural manifestation, the initiation and the propagation of seizures. Regarding the above findings, our research group focused on this review article that SUDEP could be related to the occurrence of specific brain structure dysfunction or anatomical change, at least in some cases. (Cardiol J 2009; 16, 5: 394-399)