Carbamazepine-induced cardiac dysfunction. Characterization of two distinct clinical syndromes

Kasarskis, Edward J.; Kuo, Chien-Suu; Berger, Rolando; Nelson, Kevin R.

doi:10.1001/archinte.152.1.186

Cited by 57 publications

(45 citation statements)

References 29 publications

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“…Although the use of carbamazepine could have influenced our results, this drug is associated with bradyarrhythmias and has only minor effects on QT intervals. 31,32 Further, QTc was normal during interictal periods and also we compared the effects of different seizure types within individual patients.…”

Section: Methodsmentioning

confidence: 99%

Enhanced QT shortening and persistent tachycardia after generalized seizures

Surges¹,

Scott²,

Walker³

2010

Neurology

139

111

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Objective: Generalized tonic-clonic seizures (GTCS) are a major risk factor for sudden unexpected death in epilepsy (SUDEP). We investigated whether ictal/postictal cardiac features were dependent on seizure type within individual patients.Methods: ECG data from patients with medically refractory temporal lobe epilepsy (TLE) undergoing presurgical investigation who had both complex partial seizures and secondarily GTCS during video-EEG telemetry were retrospectively reviewed. Peri-ictal heart rate (HR), corrected QT interval (QTc), HR variability, and cardiac rhythm were assessed.Results: Twenty-five patients were included in this study. Secondarily GTCS led to higher ictal HR, persistent postictal tachycardia, and decreased postictal HR variability. Moreover, abnormal shortening of QTc occurred in 17 patients mainly during the early postictal phase and significantly more often in secondarily GTCS. Abnormal QTc prolongation occurred in 3 patients with no significant association with GTCS. Benign cardiac arrhythmias occurred in 14 patients and were independent of seizure type. Conclusions:Our data suggest a substantial disturbance of autonomic function following secondarily generalized tonic-clonic seizures (GTCS) in patients with medically refractory temporal lobe epilepsy. The observed alterations could potentially facilitate sudden cardiac death and might contribute to the association of sudden unexpected death in epilepsy with GTCS. Neurology ® 2010;74:421-426 GLOSSARY CI ϭ confidence interval; CPS ϭ complex partial seizure; GTCS ϭ generalized tonic-clonic seizures; HR ϭ heart rate; HRV ϭ HR variability; QTc ϭ corrected QT interval; SUDEP ϭ sudden unexpected death in epilepsy; TLE ϭ temporal lobe epilepsy.Sudden unexpected death in epilepsy (SUDEP) is the most frequent epilepsy-related cause of death and is particularly prevalent in patients with chronic epilepsy.1 In younger people with epilepsy (age 20 -40 years), the risk for sudden death is increased about 24-fold compared to the general population.2 Peri-ictal cardiorespiratory alterations are likely to be involved in the pathophysiology of SUDEP and include tachyarrhythmias and bradyarrhythmias as well as central or obstructive hypoventilation and neurogenic pulmonary edema.1 Since generalized tonic-clonic seizures (GTCS) are a major risk factor for SUDEP, 3,4 then determining the specific cardiac characteristics of GTCS may give us a considerable insight into the mechanisms underlying SUDEP. Abnormalities in cardiac repolarization, persistent elevations of heart rate (HR) after exercise, and a decreased HR variability (HRV) are established predictors for cardiac mortality and sudden cardiac death in other medical conditions or in healthy populations. [5][6][7] Previous studies have suggested a greater impact of GTCS on cardiac excitability than nongeneralized seizures with higher ictal heart rates in chronic epilepsy and SUDEP patients 4,[8][9][10][11] and possibly more cardiac arrhythmias following GTCS. 8,10 These studies, however, are confou...

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Section: Methodsmentioning

confidence: 99%

Enhanced QT shortening and persistent tachycardia after generalized seizures

Surges¹,

Scott²,

Walker³

2010

Neurology

139

111

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“…Key Words: Epilepsy-Antiepileptic drugs-Coronary heart disease. carbamazepine (CBZ) may in fact precipitate cardiac conduction disturbances (9).…”

mentioning

confidence: 99%

Do Males 30–50 Years of Age with Chronic Epilepsy and on Long‐Term Anticonvulsant Medication Have Lower‐Than‐Expected Risk of Developing Coronary Heart Disease?

Nakken¹,

Kornstad

1998

Epilepsia

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Summary:Purpose: It has been claimed that long-term use of antiepileptic drugs (AEDs) brings about changes in the lipid profile which might resist development of cardiovascular disease. The aim of this study was to test the following hypothesis: Do males with chronic epilepsy and on long-term treatment with AEDs have a lower than expected risk of developing coronary heart disease?Methods: The coronary risk profile in 40 male patients with chronic epilepsy, aged 30-50 years, was explored, using an American individual coronary risk factor test program (the Cooper test). We made a survey of the patients' risk factors: total cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, glucose, blood pressure, body fat percentage, physical fitness, hereditary factors, smoking habits, and degree of stress. Each factor was given a score, and the sum of scores constituted the total coronary risk profile. Eighty men in the same age group, casually selected from an industrial medical service, served as controls.Results: There was no statistically significant difference in

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“…[3][4][5][6][7][8][9][10][11][12] Seizures can occur, most often in patients with a known seizure disorder 11 ; 1 study described seizures as an indicator of fatal outcome. 4 Patients with coma may develop respiratory depression requiring mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…13 Cardiac effects include sinus tachycardia in most patients and a life-threatening syndrome of heart block or bradyarrhythmias, which has been described only in elderly patients. 12 Those patients with very high levels (Ͼ85 g/mL) were found to have worse outcomes in a mixed age group, 2 but death has been reported in a pediatric patient with a moderately high peak level of 54 mg/ L. 3 A Milwaukee group determined that pediatric patients with levels Ͼ28 g/mL were at higher risk for dystonia, coma, and apnea. 10 Similarly, a group in Oregon found levels Ͼ35 mg/L in pediatric patients were significantly associated with major toxicitiesseizures, coma, and need for intubation.…”

Section: Discussionmentioning

confidence: 99%