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Bartlett-Lee B, Dervan L, Miyake C, Watson RS, Chan SW, Anderson AE, Lai YC. Association of minor electrocardiographic (ECG) abnormalities with epilepsy duration in children: A manifestation of the epileptic heart? Seizure 2024; 118:1-7. [PMID: 38613877 DOI: 10.1016/j.seizure.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE Cardiac abnormalities resulting from chronic epilepsy ("the epileptic heart") constitute a well-recognized comorbidity. However, the association of cardiac alterations with epilepsy duration remains understudied. We sought to evaluate this association using electrocardiogram (ECG). METHODS We prospectively enrolled children between 1 months and 18 years of age without known cardiac conditions or ion channelopathies during routine clinic visits. ECGs were categorized as abnormal if there were alterations in rhythm; PR, QRS, or corrected QT interval; QRS axis or morphology; ST segment or T wave. An independent association between ECG abnormalities and epilepsy duration was evaluated using multivariable logistic regression modeling. RESULTS 213 children were enrolled. 100 ECGs (47%) exhibited at least one alteration; most commonly in the ST segment (37, 17%) and T wave (29, 11%). Children with normal ECGs had shorter epilepsy duration as compared to those with ECG abnormalities (46 [18-91] months vs. 73 [32-128 months], p = 0.004). A multivariable logistic regression model demonstrated that increasing epilepsy duration was independently associated with the presence of ECG abnormalities (OR=1.09, 95% CI=1.02-1.16, p = 0.008), adjusted for seizure frequency, generalized tonic-clonic/focal to bilateral tonic-clonic seizures as the predominant seizure type, and number of channel-modifying anti-seizure medications. Increasing epilepsy duration was also independently associated with the presence of ST/T wave abnormalities (OR=1.09, 95% CI=1.01-1.16, p = 0.017), adjusted for the same covariates. SIGNIFICANCE Increasing epilepsy duration is independently associated with the presence of minor ECG abnormalities. Additional studies are needed to evaluate whether this finding may represent a manifestation of the "epileptic heart".
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Affiliation(s)
- Brittnie Bartlett-Lee
- Division of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, 6651 Main street, Houston, TX 77030, United States
| | - Leslie Dervan
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Research Institute, M/S FA2.112, 4800 Sand Point Way NE, Seattle, WA 98105, United States; Centers for Clinical and Translational Research, Seattle Children's Research Institute, M/S FA2.112, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Christina Miyake
- Division of Pediatric Cardiology, Baylor College of Medicine, 6651 Main street, Houston, TX 77030, United States
| | - R Scott Watson
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Research Institute, M/S FA2.112, 4800 Sand Point Way NE, Seattle, WA 98105, United States; Centers for Child Health, Behavior, and Development, Seattle Children's Research Institute, M/S FA2.112, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - See Wai Chan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, 6651 Main street, Houston, TX 77030, United States
| | - Anne E Anderson
- Division of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, 6651 Main street, Houston, TX 77030, United States
| | - Yi-Chen Lai
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, 6651 Main street, Houston, TX 77030, United States.
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Hamed SA, El Hadad AF, Aladawy MA. The effect of epilepsy and antiseizure medications on cardiac autonomic functions in children with epilepsy. Expert Rev Clin Pharmacol 2024; 17:393-401. [PMID: 38349326 DOI: 10.1080/17512433.2024.2318469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Autonomic manifestations have been frequently studied in adults with epilepsy. Here, we evaluated cardiac autonomic (ANS) functions in children with epilepsy in the interictal period and determined the risks for their dysfunctions. RESEARCH DESIGN AND METHODS This study included 60 patients (boys = 25; girls = 35 age: 14.53 ± 2.54 yrs) and 25 controls. Patients were well-controlled on antiseizure medications (ASMs). The battery of testing included measuring resting heart rate (HR) and blood pressure (BP), 30:15 ratio, HR variability (HRV) response to deep breathing, Valsalva ratio and BP changes in response to standing, isometric exercise and cold. RESULTS Dizziness was reported in 25%. Autonomic dysfunctions were found in 45% (n = 27). Manifestations included high frequencies of abnormal 30:15 ratio (22%), HRV responses to deep breathing (45%), Valsalava ratio (45%), and BP responses to standing (35%), isometric exercise (27%) and cold (27%), indicating parasympathetic and sympathetic hypofunctions. There were positive correlations between parasympathetic and sympathetic dysfunctions. Logistic analysis showed that the durations of epilepsy and ASMs therapy were associated with ANS dysfunctions [95% CI: 0.895-4.719, p = 0.004]. CONCLUSIONS Parasympathetic and sympathetic autonomic hypofunctions are common in children with epilepsy. This could be due to the depressant effect of sodium channel blocker ASMs on central and/or cardiac autonomic systems.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Ali Farrag El Hadad
- Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut, Egypt
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Mason F, Scarabello A, Taruffi L, Pasini E, Calandra-Buonaura G, Vignatelli L, Bisulli F. Heart Rate Variability as a Tool for Seizure Prediction: A Scoping Review. J Clin Med 2024; 13:747. [PMID: 38337440 PMCID: PMC10856437 DOI: 10.3390/jcm13030747] [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: 12/06/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The most critical burden for People with Epilepsy (PwE) is represented by seizures, the unpredictability of which severely impacts quality of life. The design of real-time warning systems that can detect or even predict ictal events would enhance seizure management, leading to high benefits for PwE and their caregivers. In the past, various research works highlighted that seizure onset is anticipated by significant changes in autonomic cardiac control, which can be assessed through heart rate variability (HRV). This manuscript conducted a scoping review of the literature analyzing HRV-based methods for detecting or predicting ictal events. An initial search on the PubMed database returned 402 papers, 72 of which met the inclusion criteria and were included in the review. These results suggest that seizure detection is more accurate in neonatal and pediatric patients due to more significant autonomic modifications during the ictal transitions. In addition, conventional metrics are often incapable of capturing cardiac autonomic variations and should be replaced with more advanced methodologies, considering non-linear HRV features and machine learning tools for processing them. Finally, studies investigating wearable systems for heart monitoring denoted how HRV constitutes an efficient biomarker for seizure detection in patients presenting significant alterations in autonomic cardiac control during ictal events.
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Affiliation(s)
- Federico Mason
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Anna Scarabello
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Lisa Taruffi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Elena Pasini
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Luca Vignatelli
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
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Alam KA, Svalastoga P, Martinez A, Glennon JC, Haavik J. Potassium channels in behavioral brain disorders. Molecular mechanisms and therapeutic potential: A narrative review. Neurosci Biobehav Rev 2023; 152:105301. [PMID: 37414376 DOI: 10.1016/j.neubiorev.2023.105301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
Potassium channels (K+-channels) selectively control the passive flow of potassium ions across biological membranes and thereby also regulate membrane excitability. Genetic variants affecting many of the human K+-channels are well known causes of Mendelian disorders within cardiology, neurology, and endocrinology. K+-channels are also primary targets of many natural toxins from poisonous organisms and drugs used within cardiology and metabolism. As genetic tools are improving and larger clinical samples are being investigated, the spectrum of clinical phenotypes implicated in K+-channels dysfunction is rapidly expanding, notably within immunology, neurosciences, and metabolism. K+-channels that previously were considered to be expressed in only a few organs and to have discrete physiological functions, have recently been found in multiple tissues and with new, unexpected functions. The pleiotropic functions and patterns of expression of K+-channels may provide additional therapeutic opportunities, along with new emerging challenges from off-target effects. Here we review the functions and therapeutic potential of K+-channels, with an emphasis on the nervous system, roles in neuropsychiatric disorders and their involvement in other organ systems and diseases.
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Affiliation(s)
| | - Pernille Svalastoga
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway; Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | | | - Jeffrey Colm Glennon
- Conway Institute for Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland.
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Norway.
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Li J, Cossette-Roberge H, Toffa DH, Deacon C, Keezer MR. Sudden unexpected death in epilepsy (SUDEP): A bibliometric analysis. Epilepsy Res 2023; 193:107159. [PMID: 37167883 DOI: 10.1016/j.eplepsyres.2023.107159] [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: 01/12/2023] [Revised: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The literature on sudden unexpected death in epilepsy (SUDEP) has been evolving at a staggering rate. We conducted a bibliometric analysis of the SUDEP literature with the aim of presenting its structure, performance, and trends. METHODS The Scopus database was searched in April 2023 for documents explicitly detailing SUDEP in their title, abstract, or keywords. After the removal of duplicate documents, bibliometric analysis was performed using the R package bibliometrix and the program VOSviewer. Performance metrics were computed to describe the literature's annual productivity, most relevant authors and countries, and most important publications. Science mapping was performed to visualize the relationships between research constituents by constructing a country collaboration network, co-authorship network, keyword co-occurrence network, and document co-citation network. RESULTS A total of 2140 documents were analyzed. These documents were published from 1989 onward, with an average number of citations per document of 25.78. Annual productivity had been on the rise since 2006. Out of 6502 authors, five authors were in both the list of the ten most productive and the list of the ten most cited authors: Devinsky O, Sander JW, Tomson T, Ryvlin P, and Lhatoo SD. The USA and the United Kingdom were the most productive and cited countries. Collaborations between American authors and European authors were particularly rich. Prominent themes in the literature included those related to pathophysiology (e.g., cardiac arrhythmia, apnea, autonomic dysfunction), epilepsy characteristics (e.g., epilepsy type, refractoriness, antiseizure medications), and epidemiology (e.g., incidence, age, sex). Emerging themes included sleep, genetics, epilepsy refractoriness, and non-human studies. SIGNIFICANCE The body of literature on SUDEP is rich, fast-growing, and benefiting from frequent international collaborations. Some research themes such as sleep, genetics, and animal studies have become more prevalent over recent years.
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Affiliation(s)
- Jimmy Li
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Hélène Cossette-Roberge
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dènahin Hinnoutondji Toffa
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
| | - Charles Deacon
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Mark Robert Keezer
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; School of Public Health, Université de Montréal, Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
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A Review on the Applications of Time-Frequency Methods in ECG Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2023. [DOI: 10.1155/2023/3145483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The joint time-frequency analysis method represents a signal in both time and frequency. Thus, it provides more information compared to other one-dimensional methods. Several researchers recently used time-frequency methods such as the wavelet transform, short-time Fourier transform, empirical mode decomposition and reported impressive results in various electrophysiological studies. The current review provides comprehensive knowledge about different time-frequency methods and their applications in various ECG-based analyses. Typical applications include ECG signal denoising, arrhythmia detection, sleep apnea detection, biometric identification, emotion detection, and driver drowsiness detection. The paper also discusses the limitations of these methods. The review will form a reference for future researchers willing to conduct research in the same field.
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King-Stephens D. Seizures and Cardiac Dysrhythmias: And the Beat (Sometimes) Goes On. Epilepsy Curr 2023; 23:32-34. [PMID: 36923342 PMCID: PMC10009112 DOI: 10.1177/15357597221135972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Serious Cardiac Arrhythmias Detected by Subcutaneous Long-Term Cardiac Monitors in Patients With Drug-Resistant Epilepsy Sivathamboo S, Liu Z, Sutherland F, Minato E, Casillas-Espinosa P, Jones NC, Todaro M, Seneviratne U, Cahill V, Yerra R, French C, Nicolo J-P, Perucca P, Kwan P, Sparks P, O’Brien TJ. Neurology. 2022;98(19):e1923-e1932. doi:10.1212/WNL.0000000000200173 Background and Objectives: Epilepsy is associated with an increased risk of cardiovascular disease and premature mortality, including sudden unexpected death in epilepsy (SUDEP). Serious cardiac arrythmias might go undetected in routine epilepsy and cardiac investigations. Methods: This prospective cohort study aimed to detect cardiac arrhythmias in patients with chronic drug-resistant epilepsy (≥5 years duration) using subcutaneous cardiac monitors for a minimum follow-up duration of 12 months. Participants with known cardiovascular disease or those with abnormal 12-lead ECGs were excluded. The device was programmed to automatically record episodes of tachycardia ≥140 beats per minute (bpm), bradycardia 40 bpm for ≥3 seconds, or asystole ≥3 seconds. Findings: Thirty-one patients underwent subcutaneous cardiac monitoring for a median recording duration of 2.2 years (range 0.5-4.2). During this time, 28 patients (90.3%) had episodes of sustained (≥30 seconds) sinus tachycardia, 8/31 (25.8%) had sinus bradycardia, and 3 (9.7%) had asystole. Three patients (9.7%) had serious cardiac arrhythmias requiring additional cardiac interventions. Among them, 2 patients had prolonged sinus arrest and ventricular asystole (>6 seconds), leading to pacemaker insertion in one, and another patient with epileptic encephalopathy had multiple episodes of recurrent nonsustained polymorphic ventricular tachycardia and bundle branch conduction abnormalities. The time to first detection of a clinically significant cardiac arrhythmia ranged between 1.2 and 26.9 months following cardiac monitor insertion. Discussion: Implantable cardiac monitors detected a high incidence of clinically significant cardiac arrhythmias in patients with chronic drug-resistant epilepsy, which may contribute to the incidence of premature mortality, including SUDEP.
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Adams T, Wagner S, Baldinger M, Zellhuber I, Weber M, Nass D, Surges R. Accurate detection of heart rate using in-ear photoplethysmography in a clinical setting. Front Digit Health 2022; 4:909519. [PMID: 36060539 PMCID: PMC9428405 DOI: 10.3389/fdgth.2022.909519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Recent research has shown that photoplethysmography (PPG) based wearable sensors offer a promising potential for chronic disease monitoring. The aim of the present study was to assess the performance of an in-ear wearable PPG sensor in acquiring valid and reliable heart rate measurements in a clinical setting, with epileptic patients. Methods Patients undergoing video-electroencephalography (EEG) monitoring with concomitant one-lead electrocardiographic (ECG) recordings were equipped with an in-ear sensor developed by cosinuss°. Results In total, 2,048 h of recording from 97 patients with simultaneous ECG and in-ear heart rate data were included in the analysis. The comparison of the quality-filtered in-ear heart rate data with the reference ECG resulted in a bias of 0.78 bpm with a standard deviation of ±2.54 bpm; Pearson’s Correlation Coefficient PCC = 0.83; Intraclass Correlation Coefficient ICC = 0.81 and mean absolute percentage error MAPE = 2.57. Conclusion These data confirm that the in-ear wearable PPG sensor provides accurate heart rate measurements in comparison with ECG under realistic clinical conditions, especially with a signal quality indicator. Further research is required to investigate whether this technology is helpful in identifying seizure-related cardiovascular changes.
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Affiliation(s)
| | | | - Melanie Baldinger
- Associate Professorship of Sport Equipment and Sport Materials, Technical University of Munich, Munich, Germany
| | | | | | - Daniel Nass
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Correspondence: Rainer Surges
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Sudden Unexpected Death in Epilepsy. Neurol Int 2022; 14:600-613. [PMID: 35893283 PMCID: PMC9326725 DOI: 10.3390/neurolint14030048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a complex neurological condition with numerous etiologies and treatment options. In a subset of these patients, sudden unexpected death can occur, and to date, there are numerous explanations as to the pathophysiological mechanisms and how to mitigate these catastrophic outcomes. Approximately 2.3 million Americans have epilepsy, and nearly 150,000 people develop the condition each year. Sudden unexpected death in epilepsy (SUDEP) accounts for 2–18% of all epilepsy-related deaths and this is equivalent to one death in 1000 person-years of diagnosed epilepsy. It is more common in young adults aged 20–45. Seizures in the past year; the absence of terminal remission in the last five years; increased seizure frequency, particularly GTCS; and nocturnal seizures are the most potent modifiable risk factors for SUDEP. Patients not receiving any antiepileptic drug therapy are at higher risk of SUDEP. Patient education on medication compliance; care plans for seizure clusters (rescue medicines); epilepsy self-management programs; and lifestyle changes to avoid seizure-triggering factors, including avoiding excessive alcohol use and sleep deprivation, should be provided by health care providers. Continued research into SUDEP will hopefully lead to effective interventions to minimize occurrences. At present, aggressive control of epilepsy and enhanced education for individuals and the public are the most effective weapons for combating SUDEP. This narrative review focuses on updated information related to SUDEP epidemiology; pathophysiology; risk factor treatment options; and finally, a discussion of important clinical studies. We seek to encourage clinicians who care for patients with epilepsy to be aggressive in controlling seizure activity and diligent in their review of risk factors and education of patients and their families about SUDEP.
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Sivathamboo S, Liu Z, Sutherland F, Minato E, Casillas-Espinosa P, Jones NC, Todaro M, Seneviratne U, Cahill V, Yerra R, French C, Nicolo JP, Perucca P, Kwan P, Sparks P, O'Brien TJ. Serious Cardiac Arrhythmias Detected by Subcutaneous Long-term Cardiac Monitors in Patients With Drug-Resistant Epilepsy. Neurology 2022; 98:e1923-e1932. [PMID: 35387849 DOI: 10.1212/wnl.0000000000200173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is associated with an increased risk of cardiovascular disease and premature mortality, including sudden unexpected death in epilepsy (SUDEP). Serious cardiac arrythmias might go undetected in routine epilepsy and cardiac investigations. METHODS This prospective cohort study aimed to detect cardiac arrhythmias in patients with chronic drug-resistant epilepsy (≥5 years duration) using subcutaneous cardiac monitors for a minimum follow-up duration of 12 months. Participants with known cardiovascular disease or those with abnormal 12-lead ECGs were excluded. The device was programmed to automatically record episodes of tachycardia ≥140 beats per minute (bpm), bradycardia ≤40 bpm for ≥3 seconds, or asystole ≥3 seconds. FINDINGS Thirty-one patients underwent subcutaneous cardiac monitoring for a median recording duration of 2.2 years (range 0.5-4.2). During this time, 28 patients (90.3%) had episodes of sustained (≥30 seconds) sinus tachycardia, 8/31 (25.8%) had sinus bradycardia, and 3 (9.7%) had asystole. Three patients (9.7%) had serious cardiac arrhythmias requiring additional cardiac interventions. Among them, 2 patients had prolonged sinus arrest and ventricular asystole (>6 seconds), leading to pacemaker insertion in one, and another patient with epileptic encephalopathy had multiple episodes of recurrent nonsustained polymorphic ventricular tachycardia and bundle branch conduction abnormalities. The time to first detection of a clinically significant cardiac arrhythmia ranged between 1.2 and 26.9 months following cardiac monitor insertion. DISCUSSION Implantable cardiac monitors detected a high incidence of clinically significant cardiac arrhythmias in patients with chronic drug-resistant epilepsy, which may contribute to the incidence of premature mortality, including SUDEP.
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Affiliation(s)
- Shobi Sivathamboo
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Zining Liu
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Fiona Sutherland
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Erica Minato
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Pablo Casillas-Espinosa
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Nigel C Jones
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Marian Todaro
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Udaya Seneviratne
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Varduhi Cahill
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Raju Yerra
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Christopher French
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - John-Paul Nicolo
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Piero Perucca
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Patrick Kwan
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Paul Sparks
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Terence J O'Brien
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
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Sanchez-Conde FG, Jimenez-Vazquez EN, Auerbach DS, Jones DK. The ERG1 K+ Channel and Its Role in Neuronal Health and Disease. Front Mol Neurosci 2022; 15:890368. [PMID: 35600076 PMCID: PMC9113952 DOI: 10.3389/fnmol.2022.890368] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
The ERG1 potassium channel, encoded by KCNH2, has long been associated with cardiac electrical excitability. Yet, a growing body of work suggests that ERG1 mediates physiology throughout the human body, including the brain. ERG1 is a regulator of neuronal excitability, ERG1 variants are associated with neuronal diseases (e.g., epilepsy and schizophrenia), and ERG1 serves as a potential therapeutic target for neuronal pathophysiology. This review summarizes the current state-of-the-field regarding the ERG1 channel structure and function, ERG1’s relationship to the mammalian brain and highlights key questions that have yet to be answered.
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Affiliation(s)
| | - Eric N. Jimenez-Vazquez
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - David S. Auerbach
- Department of Pharmacology, State University of New York Upstate Medical University, Syracuse, NY, United States
- *Correspondence: David S. Auerbach,
| | - David K. Jones
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
- David K. Jones,
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12
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Faria MT, Rodrigues S, Campelo M, Dias D, Rego R, Rocha H, Sá F, Tavares-Silva M, Pinto R, Pestana G, Oliveira A, Pereira J, Cunha JPS, Rocha-Gonçalves F, Gonçalves H, Martins E. Does the type of seizure influence heart rate variability changes? Epilepsy Behav 2022; 126:108453. [PMID: 34864377 DOI: 10.1016/j.yebeh.2021.108453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Heart rate variability (HRV), an index of the autonomic cardiac activity, is decreased in patients with epilepsy, and a low HRV is associated with a higher risk of sudden death. Generalized tonic-clonic seizures are one of the most consistent risk factors for SUDEP, but the influence (and relative risk) of each type of seizure on cardiac function is still unknown. Our objective was to assess the impact of the type of seizure (focal to bilateral tonic-clonic seizure - FBTCS - versus non-FBTCS) on periictal HRV, in a group of patients with refractory epilepsy and both types of seizures. METHODS We performed a 48-hour Holter recording on 121 patients consecutively admitted to our Epilepsy Monitoring Unit. We only included patients with both FBTCS and non-FBTCS on the Holter recording and selected the first seizure of each type to analyze. To evaluate HRV parameters (AVNN, SDNN, RMSSD, pNN20, LF, HF, and LF/HF), we chose 5-min epochs pre- and postictally. RESULTS We included 14 patients, with a median age of 36 (min-max, 16-55) years and 64% were female. Thirty-six percent had cardiovascular risk factors, but no previously known cardiac disease. In the preictal period, there were no statistically significant differences in HRV parameters, between FBTCS and non-FBTCS. In the postictal period, AVNN, RMSSD, pNN20, LF, and HF were significantly lower, and LF/HF and HR were significantly higher in FBTCS. From preictal to postictal periods, FBTCS elicited a statistically significant rise in HR and LF/HF, and a statistically significant fall in AVNN, RMSSD, pNN20, and HF. Non-FBTCS only caused statistically significant changes in HR (decrease) and AVNN (increase). SIGNIFICANCE/CONCLUSION This work emphasizes the greater effect of FBTCS in autonomic cardiac function in patients with refractory epilepsy, compared to other types of seizures, with a significant reduction in vagal tonus, which may be associated with an increased risk of SUDEP.
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Affiliation(s)
- Maria Teresa Faria
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
| | - Susana Rodrigues
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal
| | - Manuel Campelo
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Duarte Dias
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal
| | - Ricardo Rego
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Helena Rocha
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Francisca Sá
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Marta Tavares-Silva
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Gonçalo Pestana
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Ana Oliveira
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Jorge Pereira
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - João Paulo Silva Cunha
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Hernâni Gonçalves
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Faculty of Medicine, University of Porto, Portugal
| | - Elisabete Martins
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
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13
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Cammann VL, Scheitz JF, von Rennenberg R, Jäncke L, Nolte CH, Szawan KA, Stengl H, Würdinger M, Endres M, Templin C, Ghadri JR. Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome. Sci Rep 2021; 11:23555. [PMID: 34876622 PMCID: PMC8651780 DOI: 10.1038/s41598-021-01496-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/29/2021] [Indexed: 01/21/2023] Open
Abstract
Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.
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Affiliation(s)
- Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Jan F Scheitz
- Center for Stroke Research Berlin and Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Regina von Rennenberg
- Center for Stroke Research Berlin and Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,DZNE (German Center for Neurodegenerative Disease), Partner Site Berlin, Berlin, Germany
| | - Lutz Jäncke
- Division Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Christian H Nolte
- Center for Stroke Research Berlin and Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Helena Stengl
- Center for Stroke Research Berlin and Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Michael Würdinger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Matthias Endres
- Center for Stroke Research Berlin and Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZNE (German Center for Neurodegenerative Disease), Partner Site Berlin, Berlin, Germany
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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14
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Autonomic manifestations of epilepsy: emerging pathways to sudden death? Nat Rev Neurol 2021; 17:774-788. [PMID: 34716432 DOI: 10.1038/s41582-021-00574-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
Epileptic networks are intimately connected with the autonomic nervous system, as exemplified by a plethora of ictal (during a seizure) autonomic manifestations, including epigastric sensations, palpitations, goosebumps and syncope (fainting). Ictal autonomic changes might serve as diagnostic clues, provide targets for seizure detection and help us to understand the mechanisms that underlie sudden unexpected death in epilepsy (SUDEP). Autonomic alterations are generally more prominent in focal seizures originating from the temporal lobe, demonstrating the importance of limbic structures to the autonomic nervous system, and are particularly pronounced in focal-to-bilateral and generalized tonic-clonic seizures. The presence, type and severity of autonomic features are determined by the seizure onset zone, propagation pathways, lateralization and timing of the seizures, and the presence of interictal autonomic dysfunction. Evidence is mounting that not all autonomic manifestations are linked to SUDEP. In addition, experimental and clinical data emphasize the heterogeneity of SUDEP and its infrequent overlap with sudden cardiac death. Here, we review the spectrum and diagnostic value of the mostly benign and self-limiting autonomic manifestations of epilepsy. In particular, we focus on presentations that are likely to contribute to SUDEP and discuss how wearable devices might help to prevent SUDEP.
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Jahanbekam A, Baumann J, Nass RD, Bauckhage C, Hill H, Elger CE, Surges R. Performance of ECG-based seizure detection algorithms strongly depends on training and test conditions. Epilepsia Open 2021; 6:597-606. [PMID: 34250754 PMCID: PMC8408591 DOI: 10.1002/epi4.12520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
Objective To identify non‐EEG‐based signals and algorithms for detection of motor and non‐motor seizures in people lying in bed during video‐EEG (VEEG) monitoring and to test whether these algorithms work in freely moving people during mobile EEG recordings. Methods Data of three groups of adult people with epilepsy (PwE) were analyzed. Group 1 underwent VEEG with additional devices (accelerometry, ECG, electrodermal activity); group 2 underwent VEEG; and group 3 underwent mobile EEG recordings both including one‐lead ECG. All seizure types were analyzed. Feature extraction and machine‐learning techniques were applied to develop seizure detection algorithms. Performance was expressed as sensitivity, precision, F1 score, and false positives per 24 hours. Results The algorithms were developed in group 1 (35 PwE, 33 seizures) and achieved best results (F1 score 56%, sensitivity 67%, precision 45%, false positives 0.7/24 hours) when ECG features alone were used, with no improvement by including accelerometry and electrodermal activity. In group 2 (97 PwE, 255 seizures), this ECG‐based algorithm largely achieved the same performance (F1 score 51%, sensitivity 39%, precision 73%, false positives 0.4/24 hours). In group 3 (30 PwE, 51 seizures), the same ECG‐based algorithm failed to meet up with the performance in groups 1 and 2 (F1 score 27%, sensitivity 31%, precision 23%, false positives 1.2/24 hours). ECG‐based algorithms were also separately trained on data of groups 2 and 3 and tested on the data of the other groups, yielding maximal F1 scores between 8% and 26%. Significance Our results suggest that algorithms based on ECG features alone can provide clinically meaningful performance for automatic detection of all seizure types. Our study also underscores that the circumstances under which such algorithms were developed, and the selection of the training and test data sets need to be considered and limit the application of such systems to unseen patient groups behaving in different conditions.
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Affiliation(s)
| | - Jan Baumann
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Robert D Nass
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Christian Bauckhage
- Fraunhofer-Institut für Intelligente Analyse- und Informationssysteme IAIS, Sankt Augustin, Germany
| | - Holger Hill
- Mental mHealth Lab, Institut für Sport und Sportwissenschaft, Karlsruher Institut für Technologie, Karlsruhe, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Chan SW, Dervan LA, Watson RS, Anderson AE, Lai YC. Epilepsy duration is an independent factor for electrocardiographic changes in pediatric epilepsy. Epilepsia Open 2021; 6:588-596. [PMID: 34235879 PMCID: PMC8408606 DOI: 10.1002/epi4.12519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Cardiac alterations represent a potential epilepsy‐associated comorbidity. Whether cardiac changes occur as a function of epilepsy duration is not well understood. We sought to evaluate whether cardiac alterations represented a time‐dependent phenomenon in pediatric epilepsy. Methods We retrospectively followed pediatric epilepsy patients without preexisting cardiac conditions or ion channelopathies who had history of pediatric intensive care unit admission for convulsive seizures or status epilepticus between 4/2014 and 7/2017. All available 12‐lead electrocardiograms (ECGs) from these patients between 1/2006 and 5/2019 were included. We examined ECG studies for changes in rhythm; PR, QRS, or corrected QT intervals; QRS axis or morphology; ST segment; or T wave. Data were analyzed using multivariable models containing covariates associated with ECG changes or epilepsy duration from the univariate analyses. Results 127 children with 323 ECGs were included in the analyses. The median epilepsy duration was 3.9 years (IQR 1.3‐8.4 years) at the time of an ECG study and a median of 2 ECGs (IQR 1‐3) per subject. The clinical encounters associated with ECGs ranged from well‐child visits to status epilepticus. We observed changes in 171 ECGs (53%), with 83 children (65%) had at least 1 ECG with alterations. In a multivariable logistic regression model adjusting for potentially confounding variables and accounting for clustering by patient, epilepsy duration was independently associated with altered ECGs for each year of epilepsy (OR: 1.1, 95% CI: 1.0‐1.2, P = .002). Extrapolating from this model, children with epilepsy durations of 10 and 15 years had 2.9 and 4.9 times the odds of having ECG changes, respectively. Significance Cardiac alterations may become more common with increasing epilepsy duration in select pediatric epilepsy patients. Future studies are needed to determine the potential clinical implications and the generalizability of these observations.
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Affiliation(s)
- See Wai Chan
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Leslie A Dervan
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Robert Scott Watson
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Anne E Anderson
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Yi-Chen Lai
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Verrier RL, Pang TD, Nearing BD, Schachter SC. Epileptic heart: A clinical syndromic approach. Epilepsia 2021; 62:1780-1789. [PMID: 34236079 DOI: 10.1111/epi.16966] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022]
Abstract
Prevention of premature death in patients with chronic epilepsy remains a major challenge. Multiple pathophysiologic factors have been implicated, with intense investigation of cardiorespiratory mechanisms. Up to four in five patients with chronic epilepsy exhibit cardiovascular comorbidities. These findings led us to propose the concept of an "epileptic heart," defined 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." Among the most prominent changes documented in the literature are high incidence of myocardial infarction and arrhythmia, altered autonomic tone, diastolic dysfunction, hyperlipidemia, and accelerated atherosclerosis. This suite of pathologic changes prompted us to propose for the first time in this review a syndromic approach for improved clinical detection of the epileptic heart condition. In this review, we discuss the key pathophysiologic mechanisms underlying the candidate criteria along with standard and novel techniques that permit evaluation of each of these factors. Specifically, we present evidence of the utility of standard 12-lead, ambulatory, and multiday patch-based electrocardiograms, along with measures of cardiac electrical instability, including T-wave alternans, heart rate variability to detect altered autonomic tone, echocardiography to detect diastolic dysfunction, and plasma biomarkers for assessing hyperlipidemia and accelerated atherosclerosis. Ultimately, the proposed clinical syndromic approach is intended to improve monitoring and evaluation of cardiac risk in patients with chronic epilepsy to foster improved therapeutic strategies to reduce premature cardiac death.
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Affiliation(s)
- Richard L Verrier
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Trudy D Pang
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bruce D Nearing
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Steven C Schachter
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Consortia for Improving Medicine with Innovation and Technology, Boston, Massachusetts, USA
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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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Surges R. Wearables bei Epilepsien. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1353-9099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungEpileptische Anfälle führen zu verschiedensten körperlichen Symptomen, die je nach Art und Ausprägung mit geeigneten Geräten gemessen werden und als Surrogatmarker epileptischer Anfälle dienen können. Dominierende motorische Symptome können mit Beschleunigungssensoren oder elektromyografisch erfasst werden. Bei fokalen Anfällen mit fehlender oder geringer motorischer Beteiligung können autonome Phänomene wie Änderungen der Herzrate, Atmung und des elektrischen Hautwiderstandes per Elektrokardiografie, Photopletysmografie und Hautsensoren gemessen werden. Die in den heutigen Wearables integrierten Sensoren können diese Körpersignale messen und zur automatisierten Anfallserkennung nutzbar machen. In dieser Übersichtsarbeit werden verschiedene Sensortechnologien, Wearables und deren Anwendung zur automatisierten Erkennung epileptischer Anfälle vorgestellt, Gütekriterien zur Einschätzung mobiler Gesundheitstechnologien diskutiert und klinisch geprüfte Systeme zusammengefasst.
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Sivathamboo S, Constantino TN, Chen Z, Sparks PB, Goldin J, Velakoulis D, Jones NC, Kwan P, Macefield VG, O'Brien TJ, Perucca P. Cardiorespiratory and autonomic function in epileptic seizures: A video-EEG monitoring study. Epilepsy Behav 2020; 111:107271. [PMID: 32653843 DOI: 10.1016/j.yebeh.2020.107271] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Seizure-induced cardiorespiratory and autonomic dysfunction has long been recognized, and growing evidence points to its implication in sudden unexpected death in epilepsy (SUDEP). However, a comprehensive understanding of cardiorespiratory function in the preictal, ictal, and postictal periods are lacking. METHODS We examined continuous cardiorespiratory and autonomic function in 157 seizures (18 convulsive and 139 nonconvulsive) from 70 consecutive patients who had a seizure captured on concurrent video-encephalogram (EEG) monitoring and polysomnography between February 1, 2012 and May 31, 2017. Heart and respiratory rates, heart rate variability (HRV), and oxygen saturation were assessed across four distinct periods: baseline (120 s), preictal (60 s), ictal, and postictal (300 s). Heart and respiratory rates were further followed for up to 60 min after seizure termination to assess return to baseline. RESULTS Ictal tachycardia occurred during both convulsive and nonconvulsive seizures, but the maximum rate was higher for convulsive seizures (mean: 138.8 beats/min, 95% confidence interval (CI): 125.3-152.4) compared with nonconvulsive seizures (mean: 105.4 beats/min, 95% CI: 101.2-109.6; p < 0.001). Convulsive seizures were associated with a lower ictal minimum respiratory rate (mean: 0 breaths/min, 95% CI: 0-0) compared with nonconvulsive seizures (mean: 11.0 breaths/min, 95% CI: 9.5-12.6; p < 0.001). Ictal obstructive apnea was associated with convulsive compared with nonconvulsive seizures. The low-frequency (LF) power band of ictal HRV was higher among convulsive seizures than nonconvulsive seizures (ratio of means (ROM): 2.97, 95% CI: 1.34-6.60; p = 0.008). Postictal tachycardia was substantially prolonged, characterized by a longer return to baseline for convulsive seizures (median: 60.0 min, interquartile range (IQR): 46.5-60.0) than nonconvulsive seizures (median: 0.26 min, IQR: 0.008-0.9; p < 0.001). For postictal hyperventilation, the return to baseline was longer in convulsive seizures (median: 25.3 min, IQR: 8.1-60) than nonconvulsive seizures (median: 1.0 min, IQR: 0.07-3.2; p < 0.001). The LF power band of postictal HRV was lower in convulsive seizures than nonconvulsive seizures (ROM: 0.33, 95% CI: 0.11-0.96; p = 0.043). Convulsive seizures with postictal generalized EEG suppression (PGES; n = 12) were associated with lower postictal heart and respiratory rate, and increased HRV, compared with those without (n = 6). CONCLUSIONS Profound cardiorespiratory and autonomic dysfunction associated with convulsive seizures may explain why these seizures carry the greatest risk of SUDEP.
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Affiliation(s)
- Shobi Sivathamboo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3000, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia; The Epilepsy Unit, Alfred Health, Melbourne 3004, Victoria, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville 3050, Victoria, Australia.
| | - Thomas N Constantino
- Monash Centre for Astrophysics, School of Physics and Astronomy, Monash University, Clayton 3800, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3000, Victoria, Australia; The Epilepsy Unit, Alfred Health, Melbourne 3004, Victoria, Australia
| | - Paul B Sparks
- Department of Cardiology, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Jeremy Goldin
- Department of Respiratory and Sleep Disorders Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Department of Psychiatry, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Nigel C Jones
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3000, Victoria, Australia; The Epilepsy Unit, Alfred Health, Melbourne 3004, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3000, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia; The Epilepsy Unit, Alfred Health, Melbourne 3004, Victoria, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville 3050, Victoria, Australia
| | - Vaughan G Macefield
- Human Autonomic Neurophysiology, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3000, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia; The Epilepsy Unit, Alfred Health, Melbourne 3004, Victoria, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville 3050, Victoria, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3000, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia; The Epilepsy Unit, Alfred Health, Melbourne 3004, Victoria, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville 3050, Victoria, Australia
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The role of chronobiology in drug-resistance epilepsy: The potential use of a variability and chronotherapy-based individualized platform for improving the response to anti-seizure drugs. Seizure 2020; 80:201-211. [DOI: 10.1016/j.seizure.2020.06.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022] Open
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22
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Pensel MC, Nass RD, Taubøll E, Aurlien D, Surges R. Prevention of sudden unexpected death in epilepsy: current status and future perspectives. Expert Rev Neurother 2020; 20:497-508. [PMID: 32270723 DOI: 10.1080/14737175.2020.1754195] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Sudden unexpected death in epilepsy (SUDEP) affects about 1 in 1000 people with epilepsy, and even more in medically refractory epilepsy. As most people are between 20 and 40 years when dying suddenly, SUDEP leads to a considerable loss of potential life years. The most important risk factors are nocturnal and tonic-clonic seizures, underscoring that supervision and effective seizure control are key elements for SUDEP prevention. The question of whether specific antiepileptic drugs are linked to SUDEP is still controversially discussed. Knowledge and education about SUDEP among health-care professionals, patients, and relatives are of outstanding importance for preventive measures to be taken, but still poor and widely neglected.Areas covered: This article reviews epidemiology, pathophysiology, risk factors, assessment of individual SUDEP risk and available measures for SUDEP prevention. Literature search was done using Medline and Pubmed in October 2019.Expert opinion: Significant advances in the understanding of SUDEP were made in the last decade which allow testing of novel strategies to prevent SUDEP. Promising current strategies target neuronal mechanisms of brain stem dysfunction, cardiac susceptibility for fatal arrhythmias, and reliable detection of tonic-clonic seizures using mobile health technologies.Abbreviations: AED, antiepileptic drug; CBZ, carbamazepine; cLQTS, congenital long QT syndrome; EMU, epilepsy monitoring unit; FBTCS, focal to bilateral tonic-clonic seizures; GTCS, generalized tonic-clonic seizures; ICA, ictal central apnea; LTG, lamotrigine; PCCA, postconvulsive central apnea; PGES, postictal generalized EEG suppression; SRI, serotonin reuptake inhibitor; SUDEP, sudden unexpected death in epilepsy; TCS, tonic-clonic seizures.
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Affiliation(s)
| | | | - Erik Taubøll
- Department of Neurology, Oslo University Hospital, Nydalen, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dag Aurlien
- Neuroscience Research Group and Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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23
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Verrier RL, Pang TD, Nearing BD, Schachter SC. The Epileptic Heart: Concept and clinical evidence. Epilepsy Behav 2020; 105:106946. [PMID: 32109857 DOI: 10.1016/j.yebeh.2020.106946] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 12/18/2022]
Abstract
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 community-based 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.
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Affiliation(s)
- Richard L Verrier
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America.
| | - Trudy D Pang
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America
| | - Bruce D Nearing
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America
| | - Steven C Schachter
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America
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24
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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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25
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Ufongene C, El Atrache R, Loddenkemper T, Meisel C. Electrocardiographic changes associated with epilepsy beyond heart rate and their utilization in future seizure detection and forecasting methods. Clin Neurophysiol 2020; 131:866-879. [PMID: 32066106 DOI: 10.1016/j.clinph.2020.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/22/2022]
Abstract
The ability to assess seizure risk may help provide timely warnings and more personalized treatment plans for people with epilepsy (PWE). ECG changes are commonly observed in epilepsy which make ECG a promising candidate to monitor seizure risk. Most ECG research in this domain has focused on heart rate-related changes. However, several studies have identified a range of other peri-ictal ECG parameter changes that may potentially prove useful for seizure detection and forecasting. Here, we offer a systematic review of ECG changes in epilepsy outside of heart rate. We performed the systematic literature review according to PRISMA guidelines using key words related to ECG, SUDEP and epilepsy. We identified and screened 502 abstracts, read 110 full papers, and included 24 papers in the final review. Our results suggest that PWE may be more prone to cardiac conduction abnormalities than healthy controls. During interictal periods, PWE were more likely to have abnormal QTc intervals, ST segment abnormalities, elevated T Waves, early repolarization (ER), increased P Wave dispersion and PR intervals when compared to controls. Apart from these baseline abnormalities, changes during the pre-ictal and ictal states have been reported, with arrhythmias, QTc prolongation and ST segment changes being the most common. A better understanding of these state-dependent changes may afford less-cumbersome and less-stigmatizing epilepsy monitoring tools in the future.
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26
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Unravelling the mysteries of sudden unexpected death in epilepsy. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Pernice R, Faes L, Kotiuchyi I, Stivala S, Busacca A, Popov A, Kharytonov V. Time, frequency and information domain analysis of short-term heart rate variability before and after focal and generalized seizures in epileptic children. Physiol Meas 2019; 40:074003. [PMID: 30952152 DOI: 10.1088/1361-6579/ab16a3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In this work we explore the potential of combining standard time and frequency domain indexes with novel information measures, to characterize pre- and post-ictal heart rate variability (HRV) in epileptic children, with the aim of differentiating focal and generalized epilepsy regarding the autonomic control mechanisms. APPROACH We analyze short-term HRV in 37 children suffering from generalized or focal epilepsy, monitored 10 s, 300 s, 600 s and 1800 s both before and after seizure episodes. Nine indexes are computed in time (mean, standard deviation of normal-to-normal intervals, root mean square of the successive differences (RMSSD)), frequency (low-to-high frequency power ratio LF/HF, normalized LF and HF power) and information (entropy, conditional entropy and self-entropy) domains. Focal and generalized epilepsy are compared through statistical analysis of the indexes and using linear discriminant analysis (LDA). MAIN RESULTS In children with focal epilepsy, early post-ictal phase is characterized by significant tachycardia, depressed HRV, increased LF power and LF/HF, and decreased complexity, progressively recovered across time windows after the episodes. Children with generalized seizures instead show significant tachycardia, lower RMSSD, higher LF power and LF/HF ratio before the seizure. These different behaviors are exploited by LDA analysis to separate focal and generalized epilepsy up to an accuracy of 75%. Results suggest a shift of the sympatho-vagal balance towards sympathetic dominance and vagal withdrawal, noticeable just after the termination of seizure episodes and then reverted in focal epilepsy, and persistent during inter-ictal and pre-ictal periods in generalized epilepsy. SIGNIFICANCE Our analysis helps in elucidating the pathophysiology of inter-ictal HRV autonomic control and the differential diagnosis of generalized and focal epilepsy. These findings may have clinical relevance since altered sympatho-vagal control can be related to a higher danger of morbidity and mortality, may reduce thresholds for life-threatening arrhythmias, and could be a biomarker of risk for sudden unexpected death in epilepsy.
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Affiliation(s)
- Riccardo Pernice
- Dipartimento di Ingegneria, Università degli Studi di Palermo, Palermo, Italy
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28
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Nass RD, Hampel KG, Elger CE, Surges R. Blood Pressure in Seizures and Epilepsy. Front Neurol 2019; 10:501. [PMID: 31139142 PMCID: PMC6527757 DOI: 10.3389/fneur.2019.00501] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/25/2019] [Indexed: 12/18/2022] Open
Abstract
In this narrative review, we summarize the current knowledge of neurally mediated blood pressure (BP) control and discuss how recently described epilepsy- and seizure-related BP alterations may contribute to premature mortality and sudden unexpected death in epilepsy (SUDEP). Although people with epilepsy display disturbed interictal autonomic function with a shift toward predominant sympathetic activity, prevalence of arterial hypertension is similar in people with and without epilepsy. BP is transiently increased in association with most types of epileptic seizures but may also decrease in some, illustrating that seizure activity can cause both a decrease and increase of BP, probably because of stimulation or inhibition of distinct central autonomic function by epileptic activity that propagates into different neuronal networks of the central autonomic nervous system. The principal regulatory neural loop for short-term BP control is termed baroreflex, mainly involving peripheral sensors and brain stem nuclei. The baroreflex sensitivity (BRS, expressed as change of interbeat interval per change in BP) is intact after focal seizures, whereas BRS is markedly impaired in the early postictal period following generalized convulsive seizures (GCS), possibly due to metabolically mediated muscular hyperemia in skeletal muscles, a massive release of catecholamines and compromised brain stem function. Whilst most SUDEP cases are probably caused by a cardiorespiratory failure during the early postictal period following GCS, a profoundly disturbed BRS may allow a life-threatening drop of systemic BP in the aftermath of GCS, as recently reported in a patient as a plausible cause of SUDEP in a few patients.
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Affiliation(s)
- Robert D Nass
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Kevin G Hampel
- Department of Neurology, University Hospital La Fe, Valencia, Spain
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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29
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DeGiorgio CM, Curtis A, Hertling D, Moseley BD. Sudden unexpected death in epilepsy: Risk factors, biomarkers, and prevention. Acta Neurol Scand 2019; 139:220-230. [PMID: 30443951 DOI: 10.1111/ane.13049] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 01/01/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is one of the most important direct epilepsy-related causes of death, with an incidence in adults of 1.2 per 1000 person-years. Generalized tonic-clonic seizures have consistently emerged as the leading risk factor for SUDEP, particularly when such seizures are uncontrolled. High seizure burden, lack of antiepileptic drug (AED) treatment, polytherapy, intellectual disability, and prone position at the time of death are other key risk factors. Unfortunately, despite advances in treatment, overall mortality rates in epilepsy are rising. It is imperative that we learn more about SUDEP so that effective prevention strategies can be implemented. To help identify persons at greater risk of SUDEP and in need of closer monitoring, biomarkers are needed. Candidate biomarkers include electrocardiographic, electroencephalographic, and imaging abnormalities observed more frequently in those who have died suddenly and unexpectedly. As our knowledge of the pathophysiologic mechanisms behind SUDEP has increased, various preventative measures have been proposed. These include lattice pillows, postictal oxygen therapy, selective serotonin reuptake inhibitors, and inhibitors of opiate and adenosine receptors. Unfortunately, no randomized clinical trials are available to definitively conclude these measures are effective. Rather, gaining the best control of seizures possible (with AEDs, devices, and resective surgery) still remains the intervention with the best evidence to reduce the risk of SUDEP. In this evidence-based review, we explore the incidence of SUDEP and review the risk factors, biomarkers, and latest prevention strategies.
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Affiliation(s)
| | - Ashley Curtis
- Undergraduate Interdepartmental Program for Neuroscience, UCLA Los Angeles California
| | - Dieter Hertling
- Undergraduate Interdepartmental Program for Neuroscience, UCLA Los Angeles California
| | - Brian D. Moseley
- Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati Ohio
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30
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Baumgartner C, Koren J, Britto-Arias M, Schmidt S, Pirker S. Epidemiology and pathophysiology of autonomic seizures: a systematic review. Clin Auton Res 2019; 29:137-150. [DOI: 10.1007/s10286-019-00596-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/25/2019] [Indexed: 02/07/2023]
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31
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Kulju T, Haapasalo J, Rainesalo S, Lehtimäki K, Peltola J. Autostimulation in Vagus Nerve Stimulator Treatment: Modulating Neuromodulation. Neuromodulation 2018; 22:630-637. [DOI: 10.1111/ner.12897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Toni Kulju
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
| | - Joonas Haapasalo
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
| | - Sirpa Rainesalo
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
| | - Kai Lehtimäki
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
| | - Jukka Peltola
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
- Faculty of Medicine and Life SciencesUniversity of Tampere Tampere Finland
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32
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Sathyaprabha TN, Koot LAM, Hermans BHM, Adoor M, Sinha S, Kramer BW, Raju TR, Satishchandra P, Delhaas T. Effects of Chronic Carbamazepine Treatment on the ECG in Patients with Focal Seizures. Clin Drug Investig 2018; 38:845-851. [PMID: 30047104 PMCID: PMC6153966 DOI: 10.1007/s40261-018-0677-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background and Objectives Several mechanisms have been proposed for the sudden unexpected death in epilepsy patients, such as cardiac arrhythmias, a decrease in heart rate variability and the use of anti-epileptic drugs (AEDs). Although carbamazepine is commonly used as an AED, the exact working mechanism of this drug as well as its effect on the heart are not completely understood. The aim of this study was to determine whether chronic carbamazepine therapy in patients with focal seizures and impaired awareness has an effect on the electrocardiogram (ECG). Subjects and Methods This cross-sectional study included 36 patients with focal seizures and impaired awareness treated for 12–32 months with carbamazepine monotherapy and 38 healthy volunteers. A 5-min modified three-electrode chest lead ECG with lead II configuration was recorded using LabChart 7 ECG software module at 1000-Hz sampling frequency. All data analysis was performed using custom-made Matlab 2015b scripts. ECGs of patients and controls were compared with respect to heart rate, time intervals and measures of short- and long-term variation. Results There were no significant differences in heart rate and ECG time intervals between the patient and control groups. Measures on short- and long-term variability also did not show any significant group differences. Conclusion Our study shows that chronic use of carbamazepine as monotherapy does not have any significant effects on ECG time intervals or measures of short- and long-term variability.
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Affiliation(s)
- Talakad N Sathyaprabha
- Autonomic Laboratory, Department of Neurophysiology, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India
| | - Laura A M Koot
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Ben H M Hermans
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Meghana Adoor
- Autonomic Laboratory, Department of Neurophysiology, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India
| | - Boris W Kramer
- Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Trichur R Raju
- Autonomic Laboratory, Department of Neurophysiology, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India
| | | | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands. .,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
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33
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Myers KA, Sivathamboo S, Perucca P. Heart rate variability measurement in epilepsy: How can we move from research to clinical practice? Epilepsia 2018; 59:2169-2178. [PMID: 30345509 DOI: 10.1111/epi.14587] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/07/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
Abstract
Our objective was to critically evaluate the literature surrounding heart rate variability (HRV) in people with epilepsy and to make recommendations as to how future research could be directed to facilitate and accelerate integration into clinical practice. We reviewed relevant HRV publications including those involving human subjects with seizures. HRV has been studied in patients with epilepsy for more than 30 years and, overall, patients with epilepsy display altered interictal HRV, suggesting a shift in autonomic balance toward sympathetic dominance. This derangement appears more severe in those with temporal lobe epilepsy and drug-resistant epilepsy. Normal diurnal variation in HRV is also disturbed in at least some people with epilepsy, but this aspect has received less study. Some therapeutic interventions, including vagus nerve stimulation and antiepileptic medications, may partially normalize altered HRV, but studies in this area are sometimes contradictory. During seizures, the changes in HRV may be complex, but the general trend is toward a further increase in sympathetic overactivity. Research in HRV in people with epilepsy has been limited by inconsistent experimental protocols and studies that are often underpowered. HRV measurement has the potential to aid clinical epilepsy management in several possible ways. HRV may be useful in predicting which patients are likely to benefit from surgical interventions such as vagus nerve stimulation and focal cerebral resection. As well, HRV could eventually have utility as a biomarker of risk for sudden unexpected death in epilepsy (SUDEP). However, at present, the inconsistent measurement protocols used in research are hindering translation into clinical practice. A minimum protocol for HRV evaluation, to be used in all studies involving epilepsy patients, is necessary to eventually allow HRV to become a useful tool for clinicians. We propose a straightforward protocol, involving 5-minute measurements of root mean square of successive differences in wakefulness and light sleep.
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Affiliation(s)
- Kenneth A Myers
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Child Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Shobi Sivathamboo
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Piero Perucca
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
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34
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González A, Aurlien D, Haugaa KH, Taubøll E. Epilepsy in patients with long QT syndrome type 1: A Norwegian family. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:118-121. [PMID: 30406014 PMCID: PMC6215028 DOI: 10.1016/j.ebcr.2018.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 01/19/2023]
Abstract
The congenital long QT syndrome (cLQTS) is an inherited cardiac disorder and is associated with sudden cardiac death. We describe a Norwegian family with mutations within the KCNQ1 gene causing cLQTS type 1 (LQT1) and epilepsy. The index patient had Jervell and Lange-Nielsen-syndrome (JLNS) with deafness and recurrent episodes of cardiac arrhythmia. The mother and the brother have Romano-Ward syndrome (RWS) with recurrent arrhythmias. Whereas the father has focal epilepsy and genetically verified LQT1, the sister has both focal epilepsy and RWS. Our findings are consistent with the notion that mutations in the KCNQ1 gene can cause epilepsy. Mutations in the LQTS1 gene are associated with syncopes and sudden cardiac death. Our case report suggest that these mutations can also cause genuine epilepsy. Correct identification of this dual pathology may be of vital importance to patients. cLQTS should be considered a cardiocerebral channelopathy.
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Affiliation(s)
- Alba González
- Department of Neurology, Oslo University Hospital - Rikshospitalet, PO Box 4950, Nydalen, 0424 Oslo, Norway.,Faculty of Medicine, University of Oslo, PO Box 1072, Blindern, 0316 Oslo, Oslo, Norway
| | - Dag Aurlien
- Neuroscience Research Group and Department of Neurology, Stavanger University Hospital, PO Box 8100, 4068 Stavanger, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, PO Box 4950, Nydalen, 0424 Oslo, Norway.,Faculty of Medicine, University of Oslo, PO Box 1072, Blindern, 0316 Oslo, Oslo, Norway
| | - Erik Taubøll
- Department of Neurology, Oslo University Hospital - Rikshospitalet, PO Box 4950, Nydalen, 0424 Oslo, Norway.,Faculty of Medicine, University of Oslo, PO Box 1072, Blindern, 0316 Oslo, Oslo, Norway
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35
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Esmaeili B, Kaffashi F, Theeranaew W, Dabir A, Lhatoo SD, Loparo KA. Post-ictal Modulation of Baroreflex Sensitivity in Patients With Intractable Epilepsy. Front Neurol 2018; 9:793. [PMID: 30319527 PMCID: PMC6168624 DOI: 10.3389/fneur.2018.00793] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/03/2018] [Indexed: 11/20/2022] Open
Abstract
Objective: Seizure-related autonomic dysregulation occurs in epilepsy patients and may contribute to Sudden Unexpected Death in Epilepsy (SUDEP). We tested how different types of seizures affect baroreflex sensitivity (BRS) and heart rate variability (HRV). We hypothesized that BRS and HRV would be reduced after bilateral convulsive seizures (BCS). Methods: We recorded blood pressure (BP), electrocardiogram (ECG) and oxygen saturation continuously in patients (n = 18) with intractable epilepsy undergoing video-EEG monitoring. A total of 23 seizures, either focal seizures (FS, n = 14) or BCS (n = 9), were analyzed from these patients. We used 5 different HRV measurements in both the time and frequency domains to study HRV in pre- and post-ictal states. We used the average frequency domain gain, computed as the average of the magnitude ratio between the systolic BP (BPsys) and the RR-interval time series, in the low-frequency (LF) band as frequency domain index of BRS in addition to the instantaneous slope between systolic BP and RR-interval satisfying spontaneous BRS criteria as a time domain index of BRS. Results: Overall, the post-ictal modulation of HRV varied across the subjects but not specifically by the type of seizures. Comparing pre- to post-ictal epochs, the LF power of BRS decreased in 8 of 9 seizures for patients with BCS; whereas following 12 of 14 FS, BRS increased. Similarly, spontaneous BRS decreased following 7 of 9 BCS. The presence or absence of oxygen desaturation was not consistent with the changes in BRS following seizures, and the HRV does not appear to be correlated with the BRS changes. These data suggest that a transient decrease in BRS and temporary loss of cardiovascular homeostatic control can follow BCS but is unlikely following FS. Significance: These findings indicate significant post-ictal autonomic dysregulation in patients with epilepsy following BCS. Further, reduced BRS following BCS, if confirmed in future studies on SUDEP cases, may indicate one quantifiable risk marker of SUDEP.
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Affiliation(s)
- Behnaz Esmaeili
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Farhad Kaffashi
- Department of Electrical Engineering and Computer Science, Case School of Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Wanchat Theeranaew
- Department of Electrical Engineering and Computer Science, Case School of Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Aman Dabir
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Samden D Lhatoo
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Kenneth A Loparo
- Department of Electrical Engineering and Computer Science, Case School of Engineering, Case Western Reserve University, Cleveland, OH, United States
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36
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Baumgartner C, Koren JP, Rothmayer M. Automatic Computer-Based Detection of Epileptic Seizures. Front Neurol 2018; 9:639. [PMID: 30140254 PMCID: PMC6095028 DOI: 10.3389/fneur.2018.00639] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022] Open
Abstract
Automatic computer-based seizure detection and warning devices are important for objective seizure documentation, for SUDEP prevention, to avoid seizure related injuries and social embarrassments as a consequence of seizures, and to develop on demand epilepsy therapies. Automatic seizure detection systems can be based on direct analysis of epileptiform discharges on scalp-EEG or intracranial EEG, on the detection of motor manifestations of epileptic seizures using surface electromyography (sEMG), accelerometry (ACM), video detection systems and mattress sensors and finally on the assessment of changes of physiologic parameters accompanying epileptic seizures measured by electrocardiography (ECG), respiratory monitors, pulse oximetry, surface temperature sensors, and electrodermal activity. Here we review automatic seizure detection based on scalp-EEG, ECG, and sEMG. Different seizure types affect preferentially different measurement parameters. While EEG changes accompany all types of seizures, sEMG and ACM are suitable mainly for detection of seizures with major motor manifestations. Therefore, seizure detection can be optimized by multimodal systems combining several measurement parameters. While most systems provide sensitivities over 70%, specificity expressed as false alarm rates still needs to be improved. Patients' acceptance and comfort of a specific device are of critical importance for its long-term application in a meaningful clinical way.
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Affiliation(s)
- Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Johannes P Koren
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Michaela Rothmayer
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
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Asadollahi M, Shahidi M, Ramezani M, Sheibani M. Interictal electrocardiographic alternations in patients with drug-resistant epilepsy. Seizure 2018; 69:7-10. [PMID: 30952092 DOI: 10.1016/j.seizure.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Previous studies suggested the possible role of autonomic dysfunction in sudden unexpected death in epilepsy (SUDEP). The aim of this study is to assess the interictal ECG alternations especially heart rate variability (HRV), as a marker of autonomic dysfunction, in patients with drug-resistant epilepsy and determine the effect of epilepsy type and duration, seizure frequency and anti-epileptic drugs (AEDs) on ECG findings. METHODS In this comparative cross-sectional study, the interictal ECG parameters of 64 consecutive patients with drug-resistant epilepsy and the same number of age and sex-matched controls were analyzed. Epilepsy type and duration, seizure frequency, MRI findings and patients' anti-convulsive medications were determined. RESULTS Our study showed significant longer mean PR interval, shorter mean QRS duration, shorter mean QTc interval and longer corrected QT interval dispersion (QTcd) in patients with epilepsy compared to healthy subjects. The analysis of RR intervals revealed reduced RR standard deviation (SDNN), which is a marker of reduced HRV. A positive linear correlation was found between QRS duration and epilepsy duration. No significant correlation was found between taking a certain kind of AED, and ECG alternations, except for mild QTcd prolongation in patients taking valproate. CONCLUSION Our study showed clinically important alternations in interictal ECG parameters in patients with drug-resistant epilepsy which could result in sudden cardiac death.
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Affiliation(s)
- Marjan Asadollahi
- Epilepsy Department, Loghman-Hakim Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
| | - Malihe Shahidi
- Neurology Department, Loghman-Hakim Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran; Skull Base Research Center, Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahtab Ramezani
- Neurology Department, Loghman-Hakim Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehdi Sheibani
- Cardiopulmonary Research Center, Shaheed Beheshti University of Medical Science, Tehran, Iran
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Watkins L, Shankar R, Sander JW. Identifying and mitigating Sudden Unexpected Death in Epilepsy (SUDEP) risk factors. Expert Rev Neurother 2018; 18:265-274. [PMID: 29425076 DOI: 10.1080/14737175.2018.1439738] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Sudden Unexpected Death in Epilepsy (SUDEP) is a significant cause of death for people with chronic epilepsy. Good practice guidance in the UK and the USA expect SUDEP to be discussed with the individual. The event rarity, methodological variance and lack of robust research into the pathological mechanisms, associated risk factors, and management strategies have created a challenge on how and what to discuss. There are some significant associations which allows for risk assessment and mitigation. Areas covered: The current understanding of static and modifiable risk factors for SUDEP and how to manage these more effectively are reviewed. Longitudinal risk may be assessed using standardised risk assessment tools which help in communicating risk. Technological advancement allows measurement of physiological parameters associated with seizures and risk of SUDEP using small wearable devices. Further evidence is needed to demonstrate such technologies are efficacious and safe. Expert commentary: Risk reduction should be an important part of epilepsy management and we suggest a Gold Standard of Care which healthcare professionals and services should aim for when approaching SUDEP risk management. A Minimum Standard of Care is also proposed that is practical to implement, that all people with epilepsy should expect to receive.
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Affiliation(s)
- Lance Watkins
- a Neath Port Talbot CLDT, Mental Health & Learning Disability Delivery Unit , Abertawe Bro Morgannwyg University Health Board , Morriston , Swansea
| | - Rohit Shankar
- b Department of Intellectual Disability Neuropsychiatry , Cornwall Partnership NHS Foundation Trust , Truro , UK.,c Exeter Medical School, Knowledge Spa , Royal Cornwall Hospital Truro , Cornwall , UK
| | - Josemir W Sander
- d UCL Institute of Neurology , NIHR University College London Hospitals Biomedical Research Centre , London , UK.,e Chalfont Centre for Epilepsy , Buckinghamshire , UK.,f Stichting Epilepsie Instellingen Nederland (SEIN) , Heemstede , Netherlands
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Kishk NA, Sharaf Y, Ebraheim AM, Baghdady Y, Alieldin N, Afify A, Eldamaty A. Interictal cardiac repolarization abnormalities in people with epilepsy. Epilepsy Behav 2018; 79:106-111. [PMID: 29274604 DOI: 10.1016/j.yebeh.2017.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/21/2017] [Accepted: 10/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE The occurrence of cardiac electrical abnormalities such as repolarization disorders in patients with epilepsy was previously documented and may, in part, clarify the mechanism of sudden unexpected death in those patients. The aim of this study was to investigate the frequency of cardiac repolarization disorders among patients with epilepsy and whether specific demographic- or disease-related features were associated with their occurrence. SUBJECTS AND METHODS This cross-sectional study was carried out on 1000 subjects with epilepsy who were compared with age- and sex-matched 2500 subjects without epilepsy. Clinical assessment, which included careful history taking and examination, was carried out for all participants in addition to resting 12-lead electrocardiogram (ECG) recording. Electrocardiograms were reviewed by experienced cardiologists. Electrocardiogram intervals were measured, and morphological abnormalities were identified using standard guidelines. RESULTS Repolarization abnormalities were found in 142 (14.2%) patients with epilepsy. A statistically significant elevation in percentage of corrected QT interval (QTc) prolongation (both severe and borderline) among patients with epilepsy compared with controls was documented (8.4% vs 2%, P<0.001). Epilepsy increased the likelihood of hosting prolonged QTc more than 4 times (95% confidence interval: 3.175-6.515; odds ratio: 4.548; P<0.001). Affected patients were significantly older (95% confidence interval: 1.012-1.044; odds ratio: 1.027; P=0.001), and the abnormality was significantly more prevalent among those with poor seizure control (95% confidence interval: 1.103-2.966; odds ratio: 1.809; P=0.019). On the other hand, early repolarization (ER) pattern and Brugada type ECG pattern (BP) were significantly more prevalent in subjects without epilepsy. CONCLUSIONS Corrected QT interval prolongation (both severe and borderline) was more prevalent among patients with epilepsy, especially if uncontrolled or elderly. Electrocardiogram should be established as a part of the diagnostic workup of epilepsy in order to identify such electrocardiographic abnormality.
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Affiliation(s)
- Nirmeen A Kishk
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
| | - Yasser Sharaf
- Cardiology Department, Faculty of Medicine, Cairo University, Egypt
| | - Asmaa M Ebraheim
- Neurology Department, Faculty of Medicine, Cairo University, Egypt.
| | - Yasser Baghdady
- Cardiology Department, Faculty of Medicine, Cairo University, Egypt
| | - Nelly Alieldin
- Cancer Epidemiology Department, National Cancer Institute, Cairo University, Egypt
| | - Ahmed Afify
- Cardiology Department, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Eldamaty
- Cardiology Department, Faculty of Medicine, Cairo University, Egypt
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Sivathamboo S, Perucca P, Velakoulis D, Jones NC, Goldin J, Kwan P, O’Brien TJ. Sleep-disordered breathing in epilepsy: epidemiology, mechanisms, and treatment. Sleep 2018; 41:4830560. [DOI: 10.1093/sleep/zsy015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Shobi Sivathamboo
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
| | - Piero Perucca
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Department of Psychiatry, Neuropsychiatry Unit, Royal Melbourne Hospital, Victoria, Australia
| | - Nigel C Jones
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Goldin
- Department of Respiratory and Sleep Disorders Medicine, Royal Melbourne Hospital, Victoria, Australia
| | - Patrick Kwan
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Terence J O’Brien
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Bruno E, Biondi A, Richardson MP. Pre-ictal heart rate changes: A systematic review and meta-analysis. Seizure 2018; 55:48-56. [PMID: 29367145 DOI: 10.1016/j.seizure.2018.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/11/2017] [Accepted: 01/03/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To estimate the incidence of pre-ictal heart rate (HR) manifestations and to identify clinical and study-related factors modulating the estimate. METHODS We searched articles recording concurrent pre-ictal EEG and HR in adults and children with epilepsy. Pre-ictal HR changes were classified as HR reduction (HRR) or increase (HRI). Studies reporting the total number of seizures and the number of seizures with pre-ictal HR changes were included in a random-effects meta-analysis. A random-effects meta-regression was used to identify variables affecting study heterogeneity. RESULTS Thirty studies, including 1110 participants and 2957 seizures, were included. The meta-analysis showed a pooled incidence of pre-ictal HRI of 36/100 seizures (95% CI 22-50). The pre-ictal HRI incidence was 44/100 seizures (95% CI 33-55) in studies including temporal lobe epilepsy, 55/100 seizures (95% CI 41-68) in studies enrolling adults and 35/100 seizures (95% CI 16-58) when patients on antiepileptic drugs were included. The meta-regression showed that the age group, the length of the pre-ictal period, the incidence of ictal tachycardia and the time of onset of the pre-ictal HRI had a significant impact on estimates variability. The pooled incidence of pre-ictal HRR was 0/100 seizures (95% CI 0-1). CONCLUSION Review of bias evaluation and methods assessment disclosed several major limitations in the evidence-base. HR monitoring could be valuable to identify seizures prior to their apparent onset, opening the possibility to early interventions. Additional effort is necessary to delineate the target population who might benefit from its use and the mechanisms sustaining the pre-ictal cardiac changes.
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Affiliation(s)
- Elisa Bruno
- Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, UK
| | - Andrea Biondi
- Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, UK
| | - Mark P Richardson
- Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, UK.
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- Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, UK
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Ali W, Bubolz BA, Nguyen L, Castro D, Coss-Bu J, Quach MM, Kennedy CE, Anderson AE, Lai YC. Epilepsy is associated with ventricular alterations following convulsive status epilepticus in children. Epilepsia Open 2017; 2:432-440. [PMID: 29430560 PMCID: PMC5800777 DOI: 10.1002/epi4.12074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective Convulsive status epilepticus can exert profound cardiovascular effects in adults, including ventricular depolarization–repolarization abnormalities. Whether status epilepticus adversely affects ventricular electrical properties in children is less understood. Therefore, we sought to characterize ventricular alterations and the associated clinical factors in children following convulsive status epilepticus. Methods We conducted a 2‐year retrospective case–control study. Children between 1 month and 21 years of age were included if they were admitted to the pediatric intensive care unit with primary diagnosis of convulsive status epilepticus and had 12‐lead electrocardiogram (ECG) within 24 h of admission. Children with heart disease or ion channelopathy, or who were on vasoactive medications were excluded. Age‐matched control subjects had no history of seizures or epilepsy. The primary outcome was ventricular abnormalities represented by ST segment changes, abnormal T wave, QRS axis deviation, and corrected QT (QTc) interval prolongation. The secondary outcomes included QT/RR relationship, beat‐to‐beat QTc interval variability, ECG interval measurement between groups, and clinical factors associated with ECG abnormalities. Results Of 317 eligible children, 59 met the inclusion criteria. History of epilepsy was present in 31 children (epileptic) and absent in 28 children (nonepileptic). Compared with the control subjects (n = 31), the status epilepticus groups were more likely to have an abnormal ECG, with overall odds ratios of 3.8 and 7.0 for the nonepileptic and the epileptic groups, respectively. Simple linear regression analysis demonstrated that children with epilepsy exhibited impaired dependence and adaptation of the QT interval on heart rate. Beat‐to‐beat QTc interval variability, a marker of ventricular repolarization instability, was increased in children with epilepsy. Significance Convulsive status epilepticus can adversely affect ventricular electrical properties and stability in children, especially those with epilepsy. These findings suggest that children with epilepsy may be particularly vulnerable to seizure‐induced arrhythmias. Therefore, postictal cardiac surveillance may be warranted in this population.
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Affiliation(s)
- Wail Ali
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, West Virginia University, Morgantown, WV
| | - Beth A Bubolz
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Linh Nguyen
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Danny Castro
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jorge Coss-Bu
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Michael M Quach
- Section of Pediatric Neurology and Developmental Neuroscience; Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Curtis E Kennedy
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Anne E Anderson
- Section of Pediatric Neurology and Developmental Neuroscience; Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Yi-Chen Lai
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Bagnall RD, Crompton DE, Semsarian C. Genetic Basis of Sudden Unexpected Death in Epilepsy. Front Neurol 2017; 8:348. [PMID: 28775708 PMCID: PMC5517398 DOI: 10.3389/fneur.2017.00348] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
Abstract
People with epilepsy are at heightened risk of sudden death compared to the general population. The leading cause of epilepsy-related premature mortality is sudden unexpected death in epilepsy (SUDEP). Postmortem investigation of people with SUDEP, including histological and toxicological analysis, does not reveal a cause of death, and the mechanisms of SUDEP remain largely unresolved. In this review we present the possible mechanisms underlying SUDEP, including respiratory dysfunction, cardiac arrhythmia and postictal generalized electroencephlogram suppression. Emerging studies in humans and animal models suggest there may be an underlying genetic basis to SUDEP in some cases. We will highlight a mounting body of evidence for the involvement of genetic risk factors in SUDEP, with a particular focus on the role of cardiac arrhythmia genes in SUDEP.
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Affiliation(s)
- Richard D Bagnall
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Douglas E Crompton
- Department of Neurology, Northern Health, Melbourne, VIC, Australia.,Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Melbourne, VIC, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Hampel KG, Elger CE, Surges R. Impaired Baroreflex Sensitivity after Bilateral Convulsive Seizures in Patients with Focal Epilepsy. Front Neurol 2017; 8:210. [PMID: 28572789 PMCID: PMC5435824 DOI: 10.3389/fneur.2017.00210] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022] Open
Abstract
Background Sudden unexpected death in epilepsy (SUDEP) is probably due to an autonomic failure in the early postictal phase after bilateral convulsive seizures (BCS) in the majority of cases. The baroreflex sensitivity (BRS) is an established and reliable biomarker of autonomic function and sudden cardiac death. Objective To investigate whether postictal BRS depends on seizure type. Methods Beat-to-beat systemic blood pressure and heart rate were continuously and non-invasively recorded with the ccNexfin® device in patients with focal epilepsy undergoing video-EEG monitoring. BRS was calculated using the sequence as well as the spectral method. A random mixed linear model was applied to analyze the influence of seizure type on BRS during three different time periods of 15-min length each (interictal, preictal, and postictal). In addition, the possible effects of other factors (hypertension, hemispheric lateralization of ictal activity, epilepsy type, body position, vigilance state) were explored. Data are given as median with interquartile range. Results A total of 26 seizures of 26 patients were analyzed. In BCS (n = 7), BRS significantly dropped from a preictal value of 15.0 ms/mm Hg (13.0–19.4) and an interictal value of 15.6 ms/mm Hg (12.0–20.4) to 3.1 ms/mm Hg (2.7–10.5) during the postictal period (p < 0.0001) according to the sequence method. This finding was replicated with the spectral method. In contrast, focal seizures (n = 19) did not lead to significant alterations of BRS in the postictal phase. Conclusion Postictal BRS depends on the seizure type and is markedly impaired after BCS. The present study provides further evidence for a disturbed autonomic function following BCS. These findings might be related to cardiovascular failure in the context of SUDEP.
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Affiliation(s)
- Kevin G Hampel
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Multidisciplinary Epilepsy Unit, Neurology Service, University Hospital La Fe, Valencia, Spain
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Tahsili-Fahadan P, Geocadin RG. Heart-Brain Axis: Effects of Neurologic Injury on Cardiovascular Function. Circ Res 2017; 120:559-572. [PMID: 28154104 DOI: 10.1161/circresaha.116.308446] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 01/23/2023]
Abstract
A complex interaction exists between the nervous and cardiovascular systems. A large network of cortical and subcortical brain regions control cardiovascular function via the sympathetic and parasympathetic outflow. A dysfunction in one system may lead to changes in the function of the other. The effects of cardiovascular disease on the nervous system have been widely studied; however, our understanding of the effects of neurological disorders on the cardiovascular system has only expanded in the past 2 decades. Various pathologies of the nervous system can lead to a wide range of alterations in function and structure of the cardiovascular system ranging from transient and benign electrographic changes to myocardial injury, cardiomyopathy, and even cardiac death. In this article, we first review the anatomy and physiology of the central and autonomic nervous systems in regard to control of the cardiovascular function. The effects of neurological injury on cardiac function and structure will be summarized, and finally, we review neurological disorders commonly associated with cardiovascular manifestations.
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Affiliation(s)
- Pouya Tahsili-Fahadan
- From the Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology & Critical Care Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Romergryko G Geocadin
- From the Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology & Critical Care Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Hampel KG, Rocamora Zuñiga R, Quesada CM. Unravelling the mysteries of sudden unexpected death in epilepsy. Neurologia 2017; 34:527-535. [PMID: 28431832 DOI: 10.1016/j.nrl.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/01/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Sudden unexpected death in epilepsy (SUDEP) is the most frequent cause of premature death in epileptic patients. Most SUDEP events occur at night and frequently go unnoticed; the exact pathophysiological mechanisms of this phenomenon therefore remain undetermined. Nevertheless, most cases of SUDEP are attributed to an infrequent yet extremely severe complication of epileptic seizures. DEVELOPMENT We conducted a systematic literature search on PubMed. Our review article summarises scientific evidence on the classification, pathophysiological mechanisms, risk factors, biomarkers, and prevention of SUDEP. Likewise, we propose new lines of research and critically analyse findings that are relevant to clinical practice. CONCLUSIONS Current knowledge suggests that SUDEP is a heterogeneous phenomenon caused by multiple factors. In most cases, however, SUDEP is thought to be due to postictal cardiorespiratory failure triggered by generalised tonic-clonic seizures and ultimately leading to cardiac arrest. The underlying pathophysiological mechanism involves multiple factors, ranging from genetic predisposition to environmental factors. Risk of SUDEP is higher in young adults with uncontrolled generalised tonic-clonic seizures. However, patients apparently at lower risk may also experience SUDEP. Current research focuses on identifying genetic and neuroimaging biomarkers that may help determine which patients are at high risk for SUDEP. Antiepileptic treatment is the only preventive measure proven effective to date. Night-time monitoring together with early resuscitation may reduce the risk of SUDEP.
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Affiliation(s)
- K G Hampel
- Unidad Multidisciplinar de Epilepsia, Servicio de Neurología, Hospital Universitario y Politecnico La Fe, Valencia, España.
| | - R Rocamora Zuñiga
- Unidad de Epilepsia, Servicio de Neurología, Hospital del Mar-IMIM, Barcelona, España; Universitat Pompeu Fabra, Barcelona, España
| | - C M Quesada
- Klinik für Epileptologie, Universitätsklinikum Bonn, Bonn, Alemania
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Crosson J, Srivastava S, Bibat GM, Gupta S, Kantipuly A, Smith-Hicks C, Myers SM, Sanyal A, Yenokyan G, Brenner J, Naidu SR. Evaluation of QTc in Rett syndrome: Correlation with age, severity, and genotype. Am J Med Genet A 2017; 173:1495-1501. [PMID: 28394409 DOI: 10.1002/ajmg.a.38191] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/26/2017] [Accepted: 02/01/2017] [Indexed: 11/10/2022]
Abstract
Rett syndrome (RTT) is caused by MECP2 mutations, resulting in various neurological symptoms. Prolonged corrected QT interval (QTc) is also reported and is a speculated cause of sudden death in RTT. The purpose of this study was to correlate QTc in RTT patients with age, clinical severity, and genotype. 100 RTT patients (98 females, 2 males) with MECP2 mutations underwent baseline neurological evaluation (KKI-RTT Severity Scale) and QTc measurement (standard 12 lead electrocardiogram) as part of our prospective natural history study. Mean QTc of the cohort was 422.6 msec, which did not exceed the normal values for age. 7/100 patients (7%) had QTc prolongation (>450 msec). There was a trend for increasing QTc with age and clinical severity (P = 0.09). No patients with R106C, R106W, R133C, R168*, R270*, R294*, R306C, R306H, and R306P mutations demonstrated QTc prolongation. There was a relatively high proportion of QTc prolongation in patients with R255* mutations (2/8, 25%) and large deletions (1/4, 25%). The overall presence of QTc prolongation did not correlate with mutation category (P = 0.52). Our findings demonstrate that in RTT, the prevalence of QTc prolongation is lower than previously reported. Hence, all RTT patients warrant baseline ECG; if QTc is prolonged, then cardiac followup is warranted. If initial QTc is normal, then annual ECGs, particularly in younger patients, may not be necessary. However, larger sample sizes are needed to solidify the association between QTc and age and clinical severity. The biological and clinical significance of mild QTc prolongation above the normative data remains undetermined.
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Affiliation(s)
- Jane Crosson
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Genila M Bibat
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Siddharth Gupta
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland
| | - Aditi Kantipuly
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland
| | - Constance Smith-Hicks
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Scott M Myers
- Autism & Developmental Institute, Geisinger Health System, Lewisburg, Pennsylvania
| | - Abanti Sanyal
- Johns Hopkins Biostatistics Center, Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Joel Brenner
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sakkubai R Naidu
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Seizure detection and neuromodulation: A summary of data presented at the XIII conference on new antiepileptic drug and devices (EILAT XIII). Epilepsy Res 2017; 130:27-36. [DOI: 10.1016/j.eplepsyres.2017.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/08/2017] [Indexed: 01/22/2023]
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50
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Ravan M, Sabesan S, D'Cruz O. On Quantitative Biomarkers of VNS Therapy Using EEG and ECG Signals. IEEE Trans Biomed Eng 2017; 64:419-428. [DOI: 10.1109/tbme.2016.2554559] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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