High risk of developing subsequent epilepsy in patients with sleep-disordered breathing

Harnod, Tomor; Wang, Yu-Chiao; Lin, Cheng‐Li; Tseng, Chun-Hung

doi:10.1371/journal.pone.0173491

Cited by 12 publications

(5 citation statements)

References 21 publications

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“…We could identify only 1 study in the literature that estimated the effect of sleep apnea on the risk of new-onset epilepsy, and the authors reported that epilepsy risk was significantly higher among patients with sleep apnea than those without sleep apnea. 34 Therefore, it is unclear whether the imbalance in the prevalence of sleep apnea between our exposed and unexposed cohorts biased our effect estimate.…”

Section: Discussionmentioning

confidence: 93%

Epilepsy Risk Following Bariatric Surgery for Weight Loss

et al. 2022

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Background and Objectives:A previous study reported finding that epilepsy risk is elevated following bariatric surgery for weight loss; however, this association has not been adequately explored. Our objectives were to (1) estimate the risk of epilepsy following bariatric surgery for weight loss relative to a non-surgical cohort of patients with an obesity diagnosis, and (2) identify epilepsy risk factors among bariatric surgery recipients.Methods:We conducted a population-based retrospective cohort study using linked health administrative databases in Ontario, Canada. Participants were accrued between July 1, 2010, and December 31, 2016, and followed until December 31, 2019. All Ontario residents 18 years of age and older who had bariatric surgery during the accrual period were eligible for inclusion in our exposed cohort. Patients hospitalized with a diagnosis of obesity and who did not have bariatric surgery during the accrual period were eligible for inclusion in our unexposed cohort. We excluded patients with a history of seizures, epilepsy, various seizure or epilepsy risk factors, psychiatric disorders, or drug or alcohol abuse/dependence. In our primary analysis, we used inverse probability of treatment weighting to control for confounding. A marginal Cox proportional hazards model was then used to estimate the risk of epilepsy associated with bariatric surgery. A Cox model was also used to identify epilepsy risk factors among exposed participants.Results:The final sample included 16,958 exposed participants and 622,514 unexposed participants. Following inverse probability of treatment weighting, the estimated rates of epilepsy were 50.1 and 34.1 per 100,000 person-years among those who did and did not have bariatric surgery, respectively. The hazard ratio for developing epilepsy after bariatric surgery was 1.45 (95% CI=1.35, 1.56). Among participants who received bariatric surgery, stroke during follow-up increased epilepsy risk (HR=14.03, 95% CI=4.26, 46.25).Discussion:In this study, we found that patients with a history of bariatric surgery were at increased risk of developing epilepsy. These findings suggest that epilepsy is a long-term risk associated with bariatric surgery for weight loss.

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Section: Discussionmentioning

confidence: 93%

Epilepsy Risk Following Bariatric Surgery for Weight Loss

et al. 2022

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“…Sudden unexpected death in epilepsy (SUDEP) is defined as “the sudden, unexpected, witnessed or unwitnessed, nontraumatic, and nondrowning death of a patient with epilepsy with or without evidence of a seizure, excluding documented status epilepticus, and in which postmortem examination does not reveal a structural or toxicological cause of death” (Nashef, ). Also, respiratory disorders with severe hypoxic episodes such as bronchial asthma and sleep apnea could be accompanied with seizures and sudden death (Gullach et al, ; Harnod et al, ). So far, precise pathophysiological mechanisms of SUDEP and respiratory disorders‐related epilepsy and sudden death have not been fully elucidated.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a seizure accompanies postictal ventilatory depression that causes severe hypoxia and further worsens seizure status (So, 2008;Sowers, Massey, Gehlbach, Granner, & Richerson, 2013). This vicious cycle is a serious threat in patients with epileptic diseases and with respiratory disorders that could accompany hypoxic episodes, for example, bronchial asthma and sleep apnea (Gullach et al, 2015;Harnod, Wang, Lin, & Tseng, 2017). However, precise pathophysiological mechanisms of hypoxiainduced seizure and postictal ventilatory depression remain unclear.…”

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confidence: 99%

Blockade of astrocytic activation delays the occurrence of severe hypoxia‐induced seizure and respiratory arrest in mice

Fukushi

Takeda

Uchiyama

et al. 2019

J of Comparative Neurology

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Seizures are induced when subjects are exposed to severe hypoxia. It is followed by ventilatory fall‐off and eventual respiratory arrest, which may underlie the pathophysiology of death in patients with epilepsy and severe respiratory disorders. However, the mechanisms of hypoxia‐induced seizures have not been fully understood. Because astrocytes are involved in various neurological disorders, we aimed to investigate whether astrocytes are operational in seizure generation and respiratory arrest in a severe hypoxic condition. We examined the effects of astrocytic activation blockade on responses of EEG and ventilation to severe hypoxia. Adult mice were divided into two groups; in one group (n = 24) only vehicle was injected, and in the other group (n = 24) arundic acid, an inhibitory modulator of astrocytic activation, was administered before initiation of recording. After recording EEG and ventilation by whole body plethysmography in room air, the gas in the recording chamber was switched to 5% oxygen (nitrogen balanced) until a seizure and ventilatory depression occurred, followed by prompt switch back to room air. Severe hypoxia initially increased ventilation, followed by a seizure and ventilatory suppression in all mice examined. Fourteen mice without arundic acid showed respiratory arrest during loading of hypoxia. However, 22 mice pretreated with arundic acid did not suffer from respiratory arrest. Time from the onset of hypoxia to the occurrence of seizures was significantly longer in the group with arundic acid than that in the group without arundic acid. We suggest that blockade of astrocytic activation delays the occurrence of seizures and prevents respiratory arrest.

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“…Pharmaceuticals of this nature could offer the potential to preemptively impede the development of epilepsy in certain high-risk patients. [ 40 41 42 ]…”

Section: Cell Therapy For Treating Epilepsymentioning

confidence: 99%

Translating regenerative medicine techniques for the treatment of epilepsy

et al. 2017

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Epilepsy is considered a chronic neurological disorder and is accompanied by persistent and diverse disturbances in electrical brain activity. While antiepileptic pharmaceuticals are still the predominant treatment for epilepsy, the advent of numerous surgical interventions has further improved outcomes for patients. Despite these advancements, a subpopulation continues to experience intractable seizures which are resistant to current conventional and nonconventional therapeutic options. In this review, we begin with an introduction to the clinical presentation of epilepsy before discussing the clinically relevant laboratory models of epilepsy. Finally, we explore the implications of regenerative medicine – including cell therapy, neuroprotective agents, and electrical stimulation – for epilepsy, supplemented with our laboratory's data. This paper is a review article. Referred literature in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed. Some original points in this article come from the laboratory practice in our research center and the authors’ experiences.

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High risk of developing subsequent epilepsy in patients with sleep-disordered breathing

Cited by 12 publications

References 21 publications

Epilepsy Risk Following Bariatric Surgery for Weight Loss

Epilepsy Risk Following Bariatric Surgery for Weight Loss

Blockade of astrocytic activation delays the occurrence of severe hypoxia‐induced seizure and respiratory arrest in mice

Translating regenerative medicine techniques for the treatment of epilepsy

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