Epilepsy and hypertension: The possible link for sudden unexpected death in epilepsy?

Szczurkowska, Patrycja; Polonis, Katarzyna; Becari, Christiane; Hoffmann, Michal; Chrostowska, Marzena

doi:10.5603/cj.a2019.0095

Cited by 22 publications

(20 citation statements)

References 40 publications

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“…In fact, epilepsies are a heterogeneous group of disorders resulting from altered brain functions. The triggers that induce seizures in rats could involve different pathways, sometimes secondary to some pathological processes, such as hypertension and cardiovascular disturbances (Szczurkowska et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, hypertension and hyperlipidemia, two classic cardiovascular risk factors, are more prevalent than a psychiatric diagnosis in epileptic adult populations (Wilner et al, 2014). This suggests that high blood pressure may be associated with cardiovascular events and sudden death in patients with epilepsy (Szczurkowska et al, 2019). Conversely, sudden deaths observed in this group of patients may be partially related to cardiovascular abnormalities (Ngugi et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Epilepsy Seizures in Spontaneously Hypertensive Rats After Acoustic Stimulation: Role of Renin–Angiotensin System

et al. 2020

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Hypertension is a common comorbidity observed in individuals with epilepsy. Growing evidence suggests that lower blood pressure is associated with reduced frequency and severity of seizures. In this study, we sought to investigate whether the renin–angiotensin system (RAS), which is a critical regulator of blood pressure, is involved in the pathogenesis of audiogenic epilepsy-related seizures in a hypertensive rat model. Spontaneously hypertensive rats (SHRs) were given RAS inhibitors, angiotensin-converting enzyme (ACE) inhibitor or angiotensin II type I receptor (AT1R) antagonist, for 7 days prior to inducing epileptic seizures by acoustic stimulation. After the pretreatment phase, blood pressure (BP) of SHRs normalized as expected, and there was no difference in systolic and diastolic BP between the pretreated SHRs and normotensive rat group (Wistar). Next, treated and untreated SHRs (a high BP control) were individually subjected to acoustic stimuli twice a day for 2 weeks. The severity of tonic–clonic seizures and the severity of temporal lobe epilepsy seizures (product of forebrain recruitment) were evaluated by the mesencephalic severity index (Rossetti et al. scale) and the limbic index (Racine’s scale), respectively. Seizures were observed in both untreated (a high BP control) SHRs and in SHRs treated with AT1R antagonist and ACE inhibitor. There was no statistical difference in the mesencephalic severity and limbic index between these groups. Our results demonstrate that SHRs present seizure susceptibility with acoustic stimulation. Moreover, although RAS inhibitors effectively reduce blood pressure in SHR, they do not prevent developing epileptic seizures upon acoustic stimulation in SHR. In conclusion, our study shows that RAS is an unlikely link between hypertension and susceptibility to epileptic seizures induced by acoustic stimulation in SHRs, which is in contrast with the anticonvulsant effect of losartan in other animal models of epilepsy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epilepsy Seizures in Spontaneously Hypertensive Rats After Acoustic Stimulation: Role of Renin–Angiotensin System

et al. 2020

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“…Myocardial infarction and hypertension are observed vascular complications of chronic epilepsy and are the result of neurohumoral hyperstimulation and sympathetic overflow [11]. Hypertension is thought to potentiate a vicious cycle where it is not only a cause/trigger for but the effect of chronic epilepsy [10].…”

Section: Vascular Alterationsmentioning

confidence: 99%

“…Ictal catecholamine surge is an underlying common mechanism for the development of fatal rhythm disturbances in convulsive epileptic seizures [19], especially in the context of other predisposing factors. It is important to note that myocardial damage is most likely to be seen with chronic, sustained epileptic seizures [10,20].…”

Section: Ictal Arrhythmogenic Myocardiummentioning

confidence: 99%

“…Although SE is a known independent risk factor for mortality [2], cardiac complications confer worse outcomes and increased risk of mortality [3][4][5][6][7]. Cardiovascular disease risk factors, including diabetes mellitus (DM), hypertension, dyslipidemia, and heart failure, are prevalent in patients who suffer from SE [1,[8][9][10] and may determine the chronicity of resulting cardiac complications. However, even in the absence of coronary artery disease, cardiovascular dysfunction is possible [7].…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular complications of epileptic seizures

Oduah

Iwanowski

2020

Epilepsy & Behavior

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Seizure disorders are associated with multisystem complications. Cardiovascular complications account for a significant proportion of morbidity and mortality in these patients. As such, particular attention must be paid to the incidence of cardiovascular complications especially in populations at increased risk. The background for cardiac dysfunction lies in the interplay of genetic/molecular, autonomic, and iatrogenic factors that contribute to its onset. The purpose of this review was to summarize the state of literature in the last decade with regard to cardiac complications of epileptic seizures in order to increase awareness of short-and long-term debilitating cardiac complications as well as facilitate informed clinical decision-making. Taken together, the evidence provided in this review suggests that cardiac dysfunction following seizures should not be viewed as a separate entity but as an important complication of epileptic seizures. Appropriate cardiac therapy should be instituted in the postictal medical management of epileptic seizures. In acute states, postictal cardiac troponinemia (elevated cTn) should be worked up. Longer-term, monitoring for the development of cardiac structural and functional abnormalities is prudent.

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Role of the glymphatic system and perivascular spaces as a potential biomarker for post‐stroke epilepsy

Hlauschek,

Nicolo,

Sinclair

et al. 2023

Epilepsia Open

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Stroke is one of the most common causes of acquired epilepsy, which can also result in disability and increased mortality rates particularly in elderly patients. No preventive treatment for post‐stroke epilepsy is currently available. Development of such treatments has been greatly limited by the lack of biomarkers to reliably identify high‐risk patients. The glymphatic system, including perivascular spaces (PVS), is the brain's waste clearance system, and enlargement or asymmetry of PVS (ePVS) is hypothesized to play a significant role in the pathogenesis of several neurological conditions. In this article, we discuss potential mechanisms for the role of perivascular spaces in the development of post‐stroke epilepsy. Using advanced MR‐imaging techniques, it has been shown that there is asymmetry and impairment of glymphatic function in the setting of ischemic stroke. Furthermore, studies have described a dysfunction of PVS in patients with different focal and generalized epilepsy syndromes. It is thought that inflammatory processes involving PVS and the blood–brain barrier, impairment of waste clearance, and sustained hypertension affecting the glymphatic system during a seizure may play a crucial role in epileptogenesis post‐stroke. We hypothesize that impairment of the glymphatic system and asymmetry and dynamics of ePVS in the course of a stroke contribute to the development of PSE. Automated ePVS detection in stroke patients might thus assist in the identification of high‐risk patients for post‐stroke epilepsy trials.Plain Language SummaryStroke often leads to epilepsy and is one of the main causes of epilepsy in elderly patients, with no preventative treatment available. The brain’s waste removal system, called the glymphatic system which consists of perivascular spaces, may be involved. Enlargement or asymmetry of perivascular spaces could play a role in this and can be visualised with advanced brain imaging after a stroke. Detecting enlarged perivascular spaces in stroke patients could help identify those at risk for post‐stroke epilepsy.

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Epilepsy and hypertension: The possible link for sudden unexpected death in epilepsy?

Cited by 22 publications

References 40 publications

Epilepsy Seizures in Spontaneously Hypertensive Rats After Acoustic Stimulation: Role of Renin–Angiotensin System

Epilepsy Seizures in Spontaneously Hypertensive Rats After Acoustic Stimulation: Role of Renin–Angiotensin System

Cardiovascular complications of epileptic seizures

Role of the glymphatic system and perivascular spaces as a potential biomarker for post‐stroke epilepsy

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