Neural mechanisms in cardiac arrhythmias associated with epileptogenic activity: The effect of phenobarbital in the cat

Lathers, Claire M.; Schraeder, Paul L.; Carnel, Shirley B.

doi:10.1016/0024-3205(84)90123-1

Cited by 33 publications

(1 citation statement)

References 38 publications

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“…This was demonstrated by administering intravenous pentylenetetrazol to anaesthetized cats which showed that autonomic cardiac nerves did not respond in a predictable manner to changes in blood pressure, with a marked increase in variability in mean autonomic cardiac discharge and the appearance of very large increases, firstly in the variability of the discharge of the parasympathetic nerves, and then secondly in sympathetic discharge. It was shown that the altered autonomic cardiac nerve discharge was associated with interictal epileptogenic activity and arrhythmia, and was proposed that it potentially contributes to mechanisms in the pathophysiology of SUDEP [38][39][40].…”

Section: Cardiac Factorsmentioning

confidence: 98%

Sudden unexpected death in epilepsy

Johnston

Smith

2007

Expert Review of Neurotherapeutics

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Mortality in people with epilepsy is two- to three-times that of the general population. This can be attributed to epilepsy itself (epilepsy-related death) or to the underlying cause of the epilepsy. Sudden unexpected death in epilepsy (SUDEP) is the commonest cause of epilepsy-related death. It is a syndrome where a person with epilepsy dies suddenly and no other cause of death is found. There are frequent reports of persons dying alone in their sleep. It is assumed that death occurs following a seizure but since the deaths are often unwitnessed this is only an assumption. The most important risk factor appears to be poor seizure control. Lately, SUDEP has received much public interest, has been the subject of international forums, ethical debates and comprises part of national guidelines on epilepsy management. Despite its high profile, the evidence for specific risk factors and pathophysiology is still not established. Poor incident case reporting, inaccurate death certification and fewer post-mortem examinations have limited the value of epidemiological data on SUDEP. Here, we review the characteristics of SUDEP, its likely risk factors, mechanisms and differential diagnosis, and consider possible strategies for prevention. We also explore the discussion of SUDEP with patients and the management of relatives of SUDEP patients.

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Section: Cardiac Factorsmentioning

confidence: 98%

Sudden unexpected death in epilepsy

Johnston

Smith

2007

Expert Review of Neurotherapeutics

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Psychoactive Agents, Seizure Production, and Sudden Death in Epilepsy

Lipka

Lathers

1987

The Journal of Clinical Pharma

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Major tranquilizers as well as antidepressant agents have been associated with clinical seizures in patients administered these agents. The incidence of such seizures is generally low when these drugs are administered in therapeutic doses. However, administration of large doses of these agents has been associated with many cases of convulsion production. The effects that these drugs have on animal models of epilepsy have been examined. It appears that the phenothiazines act as convulsant agents at lower doses, whereas, at higher doses, they act as anticonvulsant drugs. Antidepressants, on the other hand, appear to exert an anticonvulsant effect at low doses and convulsant effects at high doses. The mechanism by which these agents alter the seizure threshold is not yet known. Clinically, drugs of lower seizure production potential should be substituted for those drugs with greater potential in treating epileptic patients for psychiatric ailments. The problem of sudden death in epileptic patients is one that must be confronted. Sudden death has most frequently been attributed to autonomic dysfunction and cardiac arrhythmia in these patients. The contribution of stress in sudden death production also must be taken into account. In addition, some psychoactive agents have been associated with sudden death as well as cardiac arrhythmia and seizure production. Thus, in light of the possible additivity of the factors involved in the production of sudden death, the administration of a psychoactive agent to an epileptic patient should be approached with caution. Those agents that do not alter cardiac rhythm or seizure threshold should be administered if a psychoactive agent is deemed necessary for the management of psychiatric illness in the epileptic patient.

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Review of Autonomic Dysfunction, Cardiac Arrhythmias, and Epileptogenic Activity

Lathers

Schraeder

1987

The Journal of Clinical Pharma

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Similarities in autonomic dysfunction associated with arrhythmias and death in animal models for digitalis toxicity, myocardial infarction, psychotropic toxicity, and epileptogenic activity are reviewed. When intravenous (IV) pentylenetetrazol was given to anesthetized cats, autonomic dysfunction was associated with both interictal and ictal epileptogenic activity. The autonomic dysfunction was manifested by the fact that autonomic cardiac nerves did not always respond in a predictable manner to changes in blood pressure, the development of a marked increase in variability in mean autonomic cardiac nerve discharge, and the appearance of a very large increase in the variability of the discharge rate of parasympathetic nerves first and then secondly in sympathetic discharge. The altered autonomic cardiac nerve discharge was associated with interictal epileptogenic activity and arrhythmia, which may contribute to sudden unexplained death in patients with epilepsy. Since phenobarbital (20 mg/kg, IV 60 min prior to pentylenetetrazol) exhibited anticonvulsant, but not antiarrhythmic and neural depressant activity, phenobarbital does not appear to be the ideal agent to prevent the autonomic dysfunction associated with epileptogenic activity in this animal model.

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Neural mechanisms in cardiac arrhythmias associated with epileptogenic activity: The effect of phenobarbital in the cat

Cited by 33 publications

References 38 publications

Sudden unexpected death in epilepsy

Sudden unexpected death in epilepsy

Psychoactive Agents, Seizure Production, and Sudden Death in Epilepsy

Review of Autonomic Dysfunction, Cardiac Arrhythmias, and Epileptogenic Activity

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