Interictal Electrocardiographic and Echocardiographic Changes in Patients With Generalized Tonic-Clonic Seizures

Ramadan, Mahmoud M.; El-Shahat, Nader; Omar, Ashraf; Gomaa, Mohamed; Belal, Tamer; Sakr, Sherif A.; Abu-Hegazy, Mohammad; Hakim, Hazem; Selim, Hatem; Omar, Sabry

doi:10.1536/ihj.54.171

Cited by 21 publications

(20 citation statements)

References 36 publications

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“…According to previous surveys, the prevalence of arterial hypertension is similar in PwE as compared to the general population (84). This is in line with smaller scope studies reporting similar interictal BP values in people with FBTCS and healthy controls (85) as well as in individuals with epilepsy who later died of SUDEP and two matched control groups with and without epilepsy (86). The authors of the latter study found, however, that DAP tended to be higher in SUDEP patients, suggesting that the sympathetic tone is elevated in this patient group (86).…”

Section: Interictal Alterations Of Blood Pressure and Baroreflex In Esupporting

confidence: 89%

Blood Pressure in Seizures and Epilepsy

et al. 2019

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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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Section: Interictal Alterations Of Blood Pressure and Baroreflex In Esupporting

confidence: 89%

Blood Pressure in Seizures and Epilepsy

et al. 2019

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“…Intermittent or permanent block of atrioventricular (AV) conduction or sinus node dysfunction are occasionally reported as side effects of sodium channel blockers . Interictal PR intervals as a measure of AV conduction have been reported to be shorter or longer in people with epilepsy as compared to controls, but conclusive data on larger study populations are lacking. Periictal bradycardia and asystole are well‐known phenomena and can occur in up to one third of individuals (but only in a small fraction of their seizures) with refractory epilepsy as assessed on long‐term ambulatory monitoring, whereas seizure‐related AV conduction blocks have been reported in some cases only .…”

Section: Risk Factors and Biomarkersmentioning

confidence: 99%

Who to target in sudden unexpected death in epilepsy prevention and how? Risk factors, biomarkers, and intervention study designs

et al. 2016

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SUMMARYThe risk of dying suddenly and unexpectedly is increased 24-to 28-fold among young people with epilepsy compared to the general population, but the incidence of sudden unexpected death in epilepsy (SUDEP) varies markedly depending on the epilepsy population. This article first reviews risk factors and biomarkers for SUDEP with the overall aim of enabling identification of epilepsy populations with different risk levels as a background for a discussion of possible intervention strategies. The by far most important clinical risk factor is frequency of generalized tonic-clonic seizures (GTCS), but nocturnal seizures, early age at onset, and long duration of epilepsy have been identified as additional risk factors. Lack of antiepileptic drug (AED) treatment or, in the context of clinical trials, adjunctive placebo versus active treatment is associated with increased risks. Despite considerable research, reliable electrophysiologic (electrocardiography [ECG] or electroencephalography [EEG]) biomarkers of SUDEP risk remain to be established. This is an important limitation for prevention strategies and intervention studies. There is a lack of biomarkers for SUDEP, and until validated biomarkers are found, the endpoint of interventions to prevent SUDEP must be SUDEP itself. These interventions, be they pharmacologic, seizure-detection devices, or nocturnal supervision, require large numbers. Possible methods for assessing prevention measures include public health community interventions, self-management, and more traditional (and much more expensive) randomized clinical trials.

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“…In most studies comparing people with epilepsy and without epilepsy, mild QTc prolongation was reported in those with epilepsy, 10–12 while others reported similar QTc durations in both groups, 13 14 or QTc shortening. 15 16 The number of people with severe QTc prolongation was not reported in these studies.…”

Section: Introductionmentioning

confidence: 96%

Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy

Lamberts

Blom

Nový

et al. 2014

Journal of Neurology, Neurosurgery & Psychiatry

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Background and aimPeople with epilepsy are at increased risk of sudden cardiac arrest (SCA) due to ECG-confirmed ventricular tachycardia/fibrillation, as seen in a community-based study. We aimed to determine whether ECG-risk markers of SCA are more prevalent in people with epilepsy.MethodsIn a cross-sectional, retrospective study, we analysed the ECG recordings of 185 people with refractory epilepsy and 178 controls without epilepsy. Data on epilepsy characteristics, cardiac comorbidity, and drug use were collected, and general ECG variables (heart rate (HR), PQ and QRS intervals) assessed. We analysed ECGs for three markers of SCA risk: severe QTc prolongation (male >450 ms, female >470 ms), Brugada ECG pattern, and early repolarisation pattern (ERP). Multivariate regression models were used to analyse differences between groups, and to identify associated clinical and epilepsy-related characteristics.ResultsPeople with epilepsy had higher HR (71 vs 62 bpm, p<0.001) and a longer PQ interval (162.8 vs 152.6 ms, p=0.001). Severe QTc prolongation and ERP were more prevalent in people with epilepsy (QTc prolongation: 5% vs 0%; p=0.002; ERP: 34% vs 13%, p<0.001), while the Brugada ECG pattern was equally frequent in both groups (2% vs 1%, p>0.999). After adjustment for covariates, epilepsy remained associated with ERP (ORadj 2.4, 95% CI 1.1 to 5.5) and severe QTc prolongation (ORadj 9.9, 95% CI 1.1 to 1317.7).ConclusionsERP and severe QTc prolongation appear to be more prevalent in people with refractory epilepsy. Future studies must determine whether this contributes to increased SCA risk in people with epilepsy.

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Interictal Electrocardiographic and Echocardiographic Changes in Patients With Generalized Tonic-Clonic Seizures

Cited by 21 publications

References 36 publications

Blood Pressure in Seizures and Epilepsy

Blood Pressure in Seizures and Epilepsy

Who to target in sudden unexpected death in epilepsy prevention and how? Risk factors, biomarkers, and intervention study designs

Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy

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