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Bhandare AM, Dale N. Neural correlate of reduced respiratory chemosensitivity during chronic epilepsy. Front Cell Neurosci 2023; 17:1288600. [PMID: 38193031 PMCID: PMC10773801 DOI: 10.3389/fncel.2023.1288600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
While central autonomic, cardiac, and/or respiratory dysfunction underlies sudden unexpected death in epilepsy (SUDEP), the specific neural mechanisms that lead to SUDEP remain to be determined. In this study, we took advantage of single-cell neuronal Ca2+ imaging and intrahippocampal kainic acid (KA)-induced chronic epilepsy in mice to investigate progressive changes in key cardiorespiratory brainstem circuits during chronic epilepsy. Weeks after induction of status epilepticus (SE), when mice were experiencing recurrent spontaneous seizures (chronic epilepsy), we observed that the adaptive ventilatory responses to hypercapnia were reduced for 5 weeks after SE induction with its partial recovery at week 7. These changes were paralleled by alterations in the chemosensory responses of neurons in the retrotrapezoid nucleus (RTN). Neurons that displayed adapting responses to hypercapnia were less prevalent and exhibited smaller responses over weeks 3-5, whereas neurons that displayed graded responses to hypercapnia became more prevalent by week 7. Over the same period, chemosensory responses of the presympathetic rostral ventrolateral medullary (RVLM) neurons showed no change. Mice with chronic epilepsy showed enhanced sensitivity to seizures, which invade the RTN and possibly put the chemosensory circuits at further risk of impairment. Our findings establish a dysfunctional breathing phenotype with its RTN neuronal correlate in mice with chronic epilepsy and suggest that the assessment of respiratory chemosensitivity may have the potential for identifying people at risk of SUDEP.
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Affiliation(s)
- Amol M. Bhandare
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
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2
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Jeon YH, Choi S, Park JH, Lee JK, Yeo NS, Lee S, Suh YL. Sudden Death Associated With Possible Flare-Ups of Multiple Sclerosis After COVID-19 Vaccination and Infection: A Case Report and Literature Review. J Korean Med Sci 2023; 38:e78. [PMID: 36918031 PMCID: PMC10010908 DOI: 10.3346/jkms.2023.38.e78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 03/06/2023] Open
Abstract
We present an autopsy case of a 19-year-old man with a history of epilepsy whose unwitnessed sudden death occurred unexpectedly in the night. About 4 years before death, he was diagnosed with unilateral optic neuritis (ON). Demyelinating disease was suspected, but he was lost to follow up after the recovery. Six months before death, he received a second dose of mRNA coronavirus disease 2019 (COVID-19) vaccine. Three months before death, he experienced epileptic seizures for the first time. Seventeen days before death, he was infected with COVID-19, which showed self-limited course under home isolation. Several days before death, he complained of seizures again at night. Autopsy revealed multifocal gray-tan discoloration in the cerebrum. Histologically, the lesions consisted of active and inactive demyelinated plaques in the perivenous area of the white matter. Perivascular lymphocytic infiltration and microglial cell proliferation were observed in both white matter and cortex. The other major organs including heart and lung were unremarkable. Based on the antemortem history and postmortem findings, the cause of death was determined to be multiple sclerosis with suspected exacerbation. The direct or indirect involvement of cortex and deep gray matter by exacerbated multiple sclerosis may explain the occurrence of seizures. Considering the absence of other structural abnormalities except the inflammatory demyelination of the cerebrum, fatal arrhythmia or laryngospasm in the terminal epileptic seizure may explain his sudden unexpected death in the benign circumstances. In this case, the onset of seizure was preceded by COVID-19 vaccination, and the exacerbation of seizure was preceded by COVID-19 infection, respectively. Literature reporting first manifestation or relapse of multiple sclerosis temporally associated with COVID-19 vaccination or infection are reviewed.
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Affiliation(s)
- Yo Han Jeon
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - Sangjoon Choi
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - Ji Hyun Park
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - Jong Kyu Lee
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - Nam Seok Yeo
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - SangHan Lee
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea.
| | - Yeon-Lim Suh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Joyal KG, Kreitlow BL, Buchanan GF. The role of sleep state and time of day in modulating breathing in epilepsy: implications for sudden unexpected death in epilepsy. Front Neural Circuits 2022; 16:983211. [PMID: 36082111 PMCID: PMC9445500 DOI: 10.3389/fncir.2022.983211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death among patients with refractory epilepsy. While the exact etiology of SUDEP is unknown, mounting evidence implicates respiratory dysfunction as a precipitating factor in cases of seizure-induced death. Dysregulation of breathing can occur in epilepsy patients during and after seizures as well as interictally, with many epilepsy patients exhibiting sleep-disordered breathing (SDB), such as obstructive sleep apnea (OSA). The majority of SUDEP cases occur during the night, with the victim found prone in or near a bed. As breathing is modulated in both a time-of-day and sleep state-dependent manner, it is relevant to examine the added burden of nocturnal seizures on respiratory function. This review explores the current state of understanding of the relationship between respiratory function, sleep state and time of day, and epilepsy. We highlight sleep as a particularly vulnerable period for individuals with epilepsy and press that this topic warrants further investigation in order to develop therapeutic interventions to mitigate the risk of SUDEP.
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Affiliation(s)
- Katelyn G. Joyal
- Interdisciplinary Graduate Program in Neuroscience, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Benjamin L. Kreitlow
- Interdisciplinary Graduate Program in Neuroscience, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Gordon F. Buchanan
- Interdisciplinary Graduate Program in Neuroscience, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- *Correspondence: Gordon F. Buchanan
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Smets H, Stumpp L, Chavez J, Cury J, Vande Perre L, Doguet P, Vanhoestenberghe A, Delbeke J, El Tahry R, Nonclercq A. Chronic recording of the vagus nerve to analyze modulations by the light-dark cycle. J Neural Eng 2022; 19. [PMID: 35764074 DOI: 10.1088/1741-2552/ac7c8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/28/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The vagus nerve is considered to play a key role in the circadian rhythm. Chronic continuous analysis of the vagus nerve activity could contribute to a better understanding of the role of the vagus nerve in light-dark modulations. This paper presents a continuous analysis of spontaneous vagus nerve activity performed in four rats. APPROACH We analyzed the vagus electroneurogram (VENG) and electroencephalogram (EEG) over a recording period of 28 days. Spike activity and heart rate estimation were derived from the VENG, and slow-wave activity was derived from the EEG. The presence of repetitive patterns was investigated with periodograms, cosinor fitting, autocorrelation, and statistical tests. The light-dark variations derived from the VENG spikes were compared with EEG slow waves, an established metric in circadian studies. RESULTS Our results demonstrate that light-dark variations can be detected in long-term vagus nerve activity monitoring. A recording period of about seven days is required to characterize accurately the VENG light-dark variations. SIGNIFICANCE As a major outcome of this study, vagus nerve recordings hold the promise to help understand circadian regulation.
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Affiliation(s)
- Hugo Smets
- BEAMS, Université Libre de Bruxelles Faculté des sciences appliquées/Ecole polytechnique, Avenue Franklin Roosevelt, 50, CP 165/56, Bruxelles, 1050, BELGIUM
| | - Lars Stumpp
- IONS, Université catholique de Louvain, Avenue Mounier 53/B1.53.05, Brussels, 1200, BELGIUM
| | - Javier Chavez
- BEAMS, Université Libre de Bruxelles Faculté des sciences appliquées/Ecole polytechnique, Avenue Franklin Roosevelt, 50, CP 165/56, Bruxelles, 1050, BELGIUM
| | - Joaquin Cury
- BEAMS, Université Libre de Bruxelles Faculté des sciences appliquées/Ecole polytechnique, Avenue Franklin Roosevelt, 50, CP 165/56, Bruxelles, 1050, BELGIUM
| | - Louis Vande Perre
- BEAMS, Université Libre de Bruxelles Faculté des sciences appliquées/Ecole polytechnique, Avenue Franklin Roosevelt, 50, CP 165/56, Bruxelles, 1050, BELGIUM
| | - Pascal Doguet
- Synergia Medical SA, Rue Emile Francqui 6, Mont-Saint-Guibert, 1435, BELGIUM
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, University College London, Brockley Hill, Aspire Create - IOMS BUilding, RNOH campus, London, HA74LP, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Jean Delbeke
- Private Address - Belgium, Seringenstraat 27, Kraainem, B-1950, BELGIUM
| | - Riëm El Tahry
- IONS, Université catholique de Louvain, Avenue Mounier 53/B1.53.05, Brussels, 1200, BELGIUM
| | - Antoine Nonclercq
- BEAMS, Université Libre de Bruxelles Faculté des sciences appliquées/Ecole polytechnique, Avenue Franklin Roosevelt, 50, CP 165/56, Bruxelles, 1050, BELGIUM
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Ong JS, Wong SN, Arulsamy A, Watterson JL, Shaikh MF. Medical Technology: A Systematic Review on Medical Devices Utilized for Epilepsy Prediction and Management. Curr Neuropharmacol 2022; 20:950-964. [PMID: 34749622 PMCID: PMC9881104 DOI: 10.2174/1570159x19666211108153001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Epilepsy is a devastating neurological disorder that affects nearly 70 million people worldwide. Epilepsy causes uncontrollable, unprovoked and unpredictable seizures that reduce the quality of life of those afflicted, with 1-9 epileptic patient deaths per 1000 patients occurring annually due to sudden unexpected death in epilepsy (SUDEP). Predicting the onset of seizures and managing them may help patients from harming themselves and may improve their well-being. For a long time, electroencephalography (EEG) devices have been the mainstay for seizure detection and monitoring. This systematic review aimed to elucidate and critically evaluate the latest advancements in medical devices, besides EEG, that have been proposed for the management and prediction of epileptic seizures. A literature search was performed on three databases, PubMed, Scopus and EMBASE. METHODS Following title/abstract screening by two independent reviewers, 27 articles were selected for critical analysis in this review. RESULTS These articles revealed ambulatory, non-invasive and wearable medical devices, such as the in-ear EEG devices; the accelerometer-based devices and the subcutaneous implanted EEG devices might be more acceptable than traditional EEG systems. In addition, extracerebral signalbased devices may be more efficient than EEG-based systems, especially when combined with an intervention trigger. Although further studies may still be required to improve and validate these proposed systems before commercialization, these findings may give hope to epileptic patients, particularly those with refractory epilepsy, to predict and manage their seizures. CONCLUSION The use of medical devices for epilepsy may improve patients' independence and quality of life and possibly prevent sudden unexpected death in epilepsy (SUDEP).
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Affiliation(s)
- Jen Sze Ong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Shuet Nee Wong
- School of Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Jessica L. Watterson
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Mohd. Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia,Address correspondence to this author at the Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia; Tel/Fax: +60 3 5514 4483; E-mail:
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6
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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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Teran FA, Bravo E, Richerson GB. Sudden unexpected death in epilepsy: Respiratory mechanisms. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:153-176. [PMID: 36031303 PMCID: PMC10191258 DOI: 10.1016/b978-0-323-91532-8.00012-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Epilepsy is one of the most common chronic neurologic diseases, with a prevalence of 1% in the US population. Many people with epilepsy live normal lives, but are at risk of sudden unexpected death in epilepsy (SUDEP). This mysterious comorbidity of epilepsy causes premature death in 17%-50% of those with epilepsy. Most SUDEP occurs after a generalized seizure, and patients are typically found in bed in the prone position. Until recently, it was thought that SUDEP was due to cardiovascular failure, but patients who died while being monitored in hospital epilepsy units revealed that most SUDEP is due to postictal central apnea. Some cases may occur when seizures invade the amygdala and activate projections to the brainstem. Evidence suggests that the pathophysiology is linked to defects in the serotonin system and central CO2 chemoreception, and that there is considerable overlap with mechanisms thought to be involved in sudden infant death syndrome (SIDS). Future work is needed to identify biomarkers for patients at highest risk, improve ascertainment, develop methods to alert caregivers when SUDEP is imminent, and find effective approaches to prevent these fatal events.
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Affiliation(s)
- Frida A Teran
- Department of Neurology, University of Iowa, Iowa City, IA, United States; Medical Scientist Training Program, University of Iowa, Iowa City, IA, United States.
| | - Eduardo Bravo
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - George B Richerson
- Department of Neurology, University of Iowa, Iowa City, IA, United States; Department of Molecular Physiology & Biophysics, University of Iowa, Iowa City, IA, United States
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Whatley BP, Winston JS, Allen LA, Vos SB, Jha A, Scott CA, Smith AL, Chowdhury FA, Bomanji JB, Lhatoo SD, Harper RM, Diehl B. Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy. Front Neurol 2021; 12:623358. [PMID: 34899550 PMCID: PMC8651549 DOI: 10.3389/fneur.2021.623358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/25/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: To characterize regional brain metabolic differences in patients at high risk of sudden unexpected death in epilepsy (SUDEP), using fluorine-18-fluorodeoxyglucose positron emission tomography (18FDG-PET). Methods: We studied patients with refractory focal epilepsy at high (n = 56) and low (n = 69) risk of SUDEP who underwent interictal 18FDG-PET as part of their pre-surgical evaluation. Binary SUDEP risk was ascertained by thresholding frequency of focal to bilateral tonic-clonic seizures (FBTCS). A whole brain analysis was employed to explore regional differences in interictal metabolic patterns. We contrasted these findings with regional brain metabolism more directly related to frequency of FBTCS. Results: Regions associated with cardiorespiratory and somatomotor regulation differed in interictal metabolism. In patients at relatively high risk of SUDEP, fluorodeoxyglucose (FDG) uptake was increased in the basal ganglia, ventral diencephalon, midbrain, pons, and deep cerebellar nuclei; uptake was decreased in the left planum temporale. These patterns were distinct from the effect of FBTCS frequency, where increasing frequency was associated with decreased uptake in bilateral medial superior frontal gyri, extending into the left dorsal anterior cingulate cortex. Significance: Regions critical to cardiorespiratory and somatomotor regulation and to recovery from vital challenges show altered interictal metabolic activity in patients with frequent FBTCS considered to be at relatively high-risk of SUDEP, and shed light on the processes that may predispose patients to SUDEP.
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Affiliation(s)
- Benjamin P Whatley
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Division of Neurology, Dalhousie University, Halifax, NS, Canada
| | - Joel S Winston
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Wellcome Trust Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
| | - Luke A Allen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom.,The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Sjoerd B Vos
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom.,The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States.,Neuroradiological Academic Unit, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Ashwani Jha
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Catherine A Scott
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - April-Louise Smith
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Fahmida A Chowdhury
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jamshed B Bomanji
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Samden D Lhatoo
- The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH, United States.,Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Ronald M Harper
- The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States.,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom.,The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States
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Acute and chronic cardiorespiratory consequences of focal intrahippocampal administration of seizure-inducing agents. Implications for SUDEP. Auton Neurosci 2021; 235:102864. [PMID: 34428716 DOI: 10.1016/j.autneu.2021.102864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022]
Abstract
The risk factors for SUDEP are undoubtedly heterogenous but the main factor is the frequency of generalized tonic-clonic seizures with apnoea and/or cardiac abnormalities likely precipitating the lethal event. By its very nature modelling SUDEP experimentally is challenging, yet insights into the nature of the lethal event and precipitating factors are vital in order to understand and prevent fatalities. Acute animal models, which induce status epilepticus (SE), can be used to help understand pathophysiological processes during and following seizures, which sometimes lead to death. The most commonly used method to induce seizures and status epilepticus is systemic administration of an ictogenic agent. Microinjection of such agents into restricted regions within the brain induces a more localised epileptic focus and circumvents the risk of direct actions on cardiorespiratory control centres. Both approaches have revealed substantial cardiovascular and respiratory consequences, including death as a result of apnoea, which may be of central origin, obstructive due to laryngospasm or, at least in genetically modified mice, a result of spreading depolarisation to medullary respiratory control centres. SUDEP is by definition a result of epilepsy, which in turn is diagnosed on the basis of two or more unprovoked seizures. The incidence of tonic-clonic seizures is the main risk factor, raising the possibility that repeated seizures cause cumulative pathological and/or pathophysiological changes that contribute to the risk of SUDEP. Chronic experimental models, which induce repeated seizures that in some cases lead to death, do show progressive development of pathophysiological changes in the myocardium, e.g. prolongation of QT the interval of the ECG or, over longer periods, ventricular hypertrophy. However, the currently available evidence indicates that seizure-related deaths are primarily due to apnoeas, but cardiac factors, particularly cumulative cardiac pathophysiologies due to repeated seizures, are potential contributing factors.
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Origin of post-ictal and post-anesthesia adverse effects and possibly of SUDEP. Med Hypotheses 2021; 151:110591. [PMID: 33873149 DOI: 10.1016/j.mehy.2021.110591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/10/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022]
Abstract
The origin of post-ictal malfunctions is debatable. We want to propose a novel idea of a cause of these adverse results occurring following epileptic seizures and anesthesia. Previously we have put forward the idea that epileptic seizures termination is caused by the function of the glymphatic system in the brain. A new measurement shows that this system can be much faster than what was estimated before. Moreover, the method enabling this speeding was actually measured in brains of epilepsy subjects. So, the main objection to our model is relegated. As a possible consequence of the glymphatic process, there can be an excess cleaning of the brain's interstitial fluid. We discuss possible adverse results of this process. This over-cleaning (that can, to a lower extent, occur also during anesthesia) which results post-ictally from the previous overexpression of fluid materials by the neurons during their seizure operation, can reduce ingredients essential for regular neuronal functioning, thereby leading to function reduction and EEG suppression which last until those materials are replenished. We argue that this ingredients' scarcity is the cause of post-ictal generalized EEG suppression (PGES), of post-ictal immobility (PI) and possibly of Sudden Unexpected Death in Epilepsy Patients (SUDEP). Similarly, such cleaning can lead to morbidity and even mortality problems following anesthesia. If our assumption is correct, this understanding of the process of the problems' origin can lead to a method to remedy them by judicial supplement of the lost materials.
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Szurhaj W, Leclancher A, Nica A, Périn B, Derambure P, Convers P, Mazzola L, Godet B, Faucanie M, Picot MC, De Jonckheere J. Cardiac Autonomic Dysfunction and Risk of Sudden Unexpected Death in Epilepsy. Neurology 2021; 96:e2619-e2626. [PMID: 33837114 DOI: 10.1212/wnl.0000000000011998] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/26/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE We aimed to test whether patients who died of sudden unexpected death in epilepsy (SUDEP) had an abnormal cardiac autonomic response to sympathetic stimulation by hyperventilation. METHODS We conducted a retrospective, observational, case-control study of a group of patients who died of SUDEP and controls who were matched to the patients for epilepsy type, drug resistance, sex, age at EEG recording, age at onset of epilepsy, and duration of epilepsy. We analyzed the heart rate (HR) and HR variability (HRV) at rest and during and after hyperventilation performed during the patient's last EEG recording before SUDEP. In each group, changes over time in HRV indexes were analyzed with linear mixed models. RESULTS Twenty patients were included in each group. In the control group, the HR increased and the root mean square of successive RR-interval differences (RMSSD) decreased during the hyperventilation and then returned to the baseline values. In the SUDEP group, however, the HR and RMSSD did not change significantly during or after hyperventilation. A difference in HR between the end of the hyperventilation and 4 minutes after its end discriminated well between patients with SUDEP and control patients (area under the receiver operating characteristic curve 0.870, sensitivity 85%, specificity 75%). CONCLUSION Most of patients with subsequent SUDEP have an abnormal cardiac autonomic response to sympathetic stimulation through hyperventilation. An index reflecting the change in HR on hyperventilation might be predictive of the risk of SUDEP and could be used to select patients at risk of SUDEP for inclusion in trials assessing protective measures.
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Affiliation(s)
- William Szurhaj
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France.
| | - Alexandre Leclancher
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Anca Nica
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Bertille Périn
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Philippe Derambure
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Philippe Convers
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Laure Mazzola
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Bertrand Godet
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Marie Faucanie
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Marie-Christine Picot
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Julien De Jonckheere
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
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12
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Manis AD, Palygin O, Isaeva E, Levchenko V, LaViolette PS, Pavlov TS, Hodges MR, Staruschenko A. Kcnj16 knockout produces audiogenic seizures in the Dahl salt-sensitive rat. JCI Insight 2021; 6:143251. [PMID: 33232300 PMCID: PMC7821607 DOI: 10.1172/jci.insight.143251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
Kir5.1 is an inwardly rectifying potassium (Kir) channel subunit abundantly expressed in the kidney and brain. We previously established the physiologic consequences of a Kcnj16 (gene encoding Kir5.1) knockout in the Dahl salt-sensitive rat (SSKcnj16-/-), which caused electrolyte/pH dysregulation and high-salt diet-induced mortality. Since Kir channel gene mutations may alter neuronal excitability and are linked to human seizure disorders, we hypothesized that SSKcnj16-/- rats would exhibit neurological phenotypes, including increased susceptibility to seizures. SSKcnj16-/- rats exhibited increased light sensitivity (fMRI) and reproducible sound-induced tonic-clonic audiogenic seizures confirmed by electroencephalography. Repeated seizure induction altered behavior, exacerbated hypokalemia, and led to approximately 38% mortality in male SSKcnj16-/- rats. Dietary potassium supplementation did not prevent audiogenic seizures but mitigated hypokalemia and prevented mortality induced by repeated seizures. These results reveal a distinct, nonredundant role for Kir5.1 channels in the brain, introduce a rat model of audiogenic seizures, and suggest that yet-to-be identified mutations in Kcnj16 may cause or contribute to seizure disorders.
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MESH Headings
- Acoustic Stimulation/adverse effects
- Animals
- Disease Models, Animal
- Electroencephalography
- Epilepsy, Reflex/etiology
- Epilepsy, Reflex/genetics
- Epilepsy, Reflex/physiopathology
- Female
- Gene Knockout Techniques
- Humans
- Hypokalemia/etiology
- Hypokalemia/genetics
- Male
- Mutation
- Potassium Channels, Inwardly Rectifying/deficiency
- Potassium Channels, Inwardly Rectifying/genetics
- Potassium Channels, Inwardly Rectifying/physiology
- Potassium, Dietary/administration & dosage
- Rats
- Rats, Inbred Dahl
- Rats, Transgenic
- Seizures/etiology
- Seizures/genetics
- Seizures/physiopathology
- Severity of Illness Index
- Kir5.1 Channel
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Affiliation(s)
| | - Oleg Palygin
- Department of Physiology
- Cardiovascular Center, and
| | | | | | - Peter S. LaViolette
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Alexander Staruschenko
- Department of Physiology
- Cardiovascular Center, and
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
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13
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Stewart M, Silverman JB, Sundaram K, Kollmar R. Causes and Effects Contributing to Sudden Death in Epilepsy and the Rationale for Prevention and Intervention. Front Neurol 2020; 11:765. [PMID: 32849221 PMCID: PMC7411179 DOI: 10.3389/fneur.2020.00765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) claims the lives of one in every thousand epileptic patients each year. Autonomic, cardiac, and respiratory pieces to a mechanistic puzzle have not yet been completely assembled. We propose a single sequence of causes and effects that unifies disparate and competitive concepts into a single algorithm centered on ictal obstructive apnea. Based on detailed animal studies that are sometimes impossible in humans, and striking parallels with a growing body of clinical examples, this framework (1) accounts for the autonomic, cardiac, and respiratory data to date by showing the causal relationships between specific elements, and (2) highlights specific kinds of data that can be used to precisely classify various patient outcomes. The framework also justifies a “near miss” designation to be applied to any cases with evidence of obstructive apnea even, and perhaps especially, in individuals that do not require resuscitation. Lastly, the rationale for preventative oxygen therapy is demonstrated. With better mechanistic understanding of SUDEP, we suggest changes for detection and classification to increase survival rates and improve risk stratification.
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Affiliation(s)
- Mark Stewart
- Department of Neurology, State University of New York Health Sciences University, Brooklyn, NY, United States.,Department of Physiology & Pharmacology, State University of New York Health Sciences University, Brooklyn, NY, United States
| | - Joshua B Silverman
- Department of Otolaryngology, North Shore Long Island Jewish Medical Center, New Hyde Park, NY, United States
| | - Krishnamurthi Sundaram
- Department of Otolaryngology, State University of New York Health Sciences University, Brooklyn, NY, United States
| | - Richard Kollmar
- Department of Otolaryngology, State University of New York Health Sciences University, Brooklyn, NY, United States.,Department of Cell Biology, State University of New York Health Sciences University, Brooklyn, NY, United States
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14
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Panneton WM, Gan Q. The Mammalian Diving Response: Inroads to Its Neural Control. Front Neurosci 2020; 14:524. [PMID: 32581683 PMCID: PMC7290049 DOI: 10.3389/fnins.2020.00524] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/27/2020] [Indexed: 01/03/2023] Open
Abstract
The mammalian diving response (DR) is a remarkable behavior that was first formally studied by Laurence Irving and Per Scholander in the late 1930s. The DR is called such because it is most prominent in marine mammals such as seals, whales, and dolphins, but nevertheless is found in all mammals studied. It consists generally of breathing cessation (apnea), a dramatic slowing of heart rate (bradycardia), and an increase in peripheral vasoconstriction. The DR is thought to conserve vital oxygen stores and thus maintain life by directing perfusion to the two organs most essential for life-the heart and the brain. The DR is important, not only for its dramatic power over autonomic function, but also because it alters normal homeostatic reflexes such as the baroreceptor reflex and respiratory chemoreceptor reflex. The neurons driving the reflex circuits for the DR are contained within the medulla and spinal cord since the response remains after the brainstem transection at the pontomedullary junction. Neuroanatomical and physiological data suggesting brainstem areas important for the apnea, bradycardia, and peripheral vasoconstriction induced by underwater submersion are reviewed. Defining the brainstem circuit for the DR may open broad avenues for understanding the mechanisms of suprabulbar control of autonomic function in general, as well as implicate its role in some clinical states. Knowledge of the proposed diving circuit should facilitate studies on elite human divers performing breath-holding dives as well as investigations on sudden infant death syndrome (SIDS), stroke, migraine headache, and arrhythmias. We have speculated that the DR is the most powerful autonomic reflex known.
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Affiliation(s)
- W. Michael Panneton
- Department of Pharmacological and Physiological Science, School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Qi Gan
- Department of Pharmacological and Physiological Science, School of Medicine, Saint Louis University, St. Louis, MO, United States
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, MO, United States
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15
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Jefferys JGR, Ashby‐Lumsden A, Lovick TA. Cardiac effects of repeated focal seizures in rats induced by intrahippocampal tetanus toxin: Bradyarrhythmias, tachycardias, and prolonged interictal QT interval. Epilepsia 2020; 61:798-809. [DOI: 10.1111/epi.16479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- John G. R. Jefferys
- Department of Pharmacology Oxford University Oxford UK
- School of Clinical & Experimental Medicine The University of Birmingham Birmingham UK
- School of Biomedical Engineering Purdue University West Lafayette Indiana
- Department of Physiology 2nd Medical School Motol, Charles University Prague Czech Republic
| | - Alexander Ashby‐Lumsden
- Department of Pharmacology Oxford University Oxford UK
- School of Clinical & Experimental Medicine The University of Birmingham Birmingham UK
| | - Thelma A. Lovick
- School of Biomedical Engineering Purdue University West Lafayette Indiana
- School of Physiology, Pharmacology and Neuroscience The University of Bristol Bristol UK
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16
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Abstract
PURPOSE OF REVIEW The current review updates our knowledge regarding sudden unexpected death in epilepsy patient (SUDEP) risks, risk factors, and investigations of putative biomarkers based on suspected mechanisms of SUDEP. RECENT FINDINGS The overall incidence of SUDEP in adults with epilepsy is 1.2/1000 patient-years, with surprisingly comparable figures in children in recently published population-based studies. This risk was found to decrease over time in several cohorts at a rate of -7% per year, for unknown reasons. Well established risk factors include frequency of generalized tonic-clonic seizures, while adding antiepileptic treatment, nocturnal supervision and use of nocturnal listening device appear to be protective. In contrast, recent data failed to demonstrate the predictive value of heart rate variability, periictal cardiorespiratory dysfunction, and postictal generalized electroencephalography suppression. Preliminary findings suggest that brainstem and thalamic atrophy may be associated with a higher risk of SUDEP. Novel experimental and human data support the primary role of generalized tonic-clonic seizure-triggered respiratory dysfunction and the likely contribution of altered brainstem serotoninergic neurotransmission, in SUDEP pathophysiology. SUMMARY Although significant progress has been made during the past year in the understanding of SUDEP mechanisms and investigation of numerous potential biomarkers, we are still missing reliable predictors of SUDEP beyond the well established clinical risk factors.
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17
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Jefferys JGR, Arafat MA, Irazoqui PP, Lovick TA. Brainstem activity, apnea, and death during seizures induced by intrahippocampal kainic acid in anaesthetized rats. Epilepsia 2019; 60:2346-2358. [PMID: 31705531 DOI: 10.1111/epi.16374] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- John G. R. Jefferys
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN USA
- Department of Pharmacology Oxford University Oxford UK
| | - Muhammad A. Arafat
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN USA
- Department of Electrical and Computer Engineering Purdue University West Lafayette IN USA
| | - Pedro P. Irazoqui
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN USA
- Department of Electrical and Computer Engineering Purdue University West Lafayette IN USA
| | - Thelma A. Lovick
- Weldon School of Biomedical Engineering Purdue University West Lafayette IN USA
- School of Physiology, Pharmacology and Neuroscience University of Bristol Bristol UK
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18
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Stewart M. Transformed ECG Signals Highlight Similarities Between Obstructive Sleep Apnea and Obstructive Apnea due to Seizure-Induced Laryngospasm. J Clin Sleep Med 2019; 15:1859. [PMID: 31855171 DOI: 10.5664/jcsm.8102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mark Stewart
- SUNY Downstate Medical Center, School of Graduate Studies, Brooklyn, New York
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19
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Seo MH, Sung WY. A case of near-sudden unexpected death in epilepsy due to ventricular fibrillation. Open Access Emerg Med 2019; 11:161-166. [PMID: 31410072 PMCID: PMC6650453 DOI: 10.2147/oaem.s214619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/05/2019] [Indexed: 12/31/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) refers to the sudden and unexpected death of an epileptic patient with no other health issues, during normal activity, and for whom no other particular cause of death can be found. The exact cause of SUDEP has not been established yet; however, it is assumed to be caused by multiple organ failure involving the respiratory and cardiovascular systems. Some of the known risk factors are generalized tonic-clonic seizure, frequent epileptic seizure, early onset of epilepsy, long duration of seizure, nocturnal seizure, and combined therapy with antiepileptics. A number of seizure-related cardiac arrhythmia cases have been reported. Arrhythmias are mostly benign tachycardia or bradycardia, and ventricular fibrillation (VF) or asystole is very rare. It is considered that fatal cardiac arrhythmia is a cause of SUDEP. Here, we describe the case of a near-SUDEP patient who was successfully revived without complications by immediate defibrillation with an automated external defibrillator and cardiopulmonary resuscitation, although VF occurred after a convulsive seizure. Based on our experience, when treating a patient with an epileptic seizure, one should always keep in mind the possibility of SUDEP as a seizure-induced emergency situation involving fatal arrhythmia and cardiac arrest, even in young healthy adults.
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Affiliation(s)
- Myung Ha Seo
- Department of Emergency Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Won Young Sung
- Department of Emergency Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea
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20
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Buchanan GF. Impaired CO 2-Induced Arousal in SIDS and SUDEP. Trends Neurosci 2019; 42:242-250. [PMID: 30905388 DOI: 10.1016/j.tins.2019.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/21/2019] [Accepted: 02/06/2019] [Indexed: 12/24/2022]
Abstract
Premature, sudden death is devastating. Certain patient populations are at greater risk to succumb to sudden death. For instance, infants under 1year of age are at risk for sudden infant death syndrome (SIDS), and patients with epilepsy are at risk for sudden unexpected death in epilepsy (SUDEP). Deaths are attributed to these syndromic entities in these select populations when other diagnoses have been excluded. There are a number of similarities between these syndromes, and the commonalities suggest that the two syndromes may share certain etiological features. One such feature may be deficiency of arousal to CO2. Under normal conditions, CO2 is a potent arousal stimulus. Circumstances surrounding SIDS and SUDEP deaths often facilitate CO2 elevation, and faulty CO2 arousal mechanisms could, at least in part, contribute to death.
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Affiliation(s)
- Gordon F Buchanan
- Department of Neurology and Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
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21
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Diving responses elicited by nasopharyngeal irrigation mimic seizure-associated central apneic episodes in a rat model. Neurobiol Dis 2019; 124:408-415. [DOI: 10.1016/j.nbd.2018.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/28/2018] [Accepted: 12/24/2018] [Indexed: 01/09/2023] Open
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