The heart of epilepsy: Current views and future concepts

Abstract

Cardiovascular (CV) comorbidities are common in people with epilepsy. Several mechanisms explain why these conditions tend to co-exist including causal associations, shared risk factors and those resulting from epilepsy or its treatment. Various arrhythmias occurring during and after seizures have been described. Ictal asystole is the most common cause. The converse phenomenon, arrhythmias causing seizures, appears extremely rare and has only been reported in children following cardioinihibitory syncope. Arrhythmias in epilepsy may not only result from seizure activity but also from a shared genetic susceptibility. Various cardiac and epilepsy genes could be implicated but firm evidence is still lacking. Several antiepileptic drugs (AEDs) triggering conduction abnormalities can also explain the co-existence of arrhythmias in epilepsy. Epidemiological studies have consistently shown that people with epilepsy have a higher prevalence of structural cardiac disease and a poorer CV risk profile than those without epilepsy. Shared CV risk factors, genetics and etiological factors can account for a significant part of the relationship between epilepsy and structural cardiac disease. Seizure activity may cause transient myocardial ischaemia and the Takotsubo syndrome. Additionally, certain AEDs may themselves negatively affect CV risk profile in epilepsy. Here we discuss the fascinating borderland of epilepsy and cardiovascular conditions. The review focuses on epidemiology, clinical presentations and possible mechanisms for shared pathophysiology. It concludes with a discussion of future developments and a call for validated screening instruments and guidelines aiding the early identification and treatment of CV comorbidity in epilepsy.

Ryanodine receptor 2 (RYR2) mutation: A potentially novel neurocardiac calcium channelopathy manifesting as primary generalised epilepsy

“…Seizure generation in our RYR2 mutation-positive patient may be secondary to an initial undetected cardiac arrhythmogenic event leading to apnoea and cerebral anoxia; however this phenomenon is rare and subject to controversy. 12 Meanwhile, ictal and post-ictal cardiac arrhythmias and autonomic dysfunction are well-described [12].…”

“…Seizure: European Journal of Epilepsy 67 (2019) [11][12][13][14] analytic tools have predicted this missense variant to be damaging [2]. This variant is absent in the Genome Aggregation Database [2].…”

Comorbidities of Refractory Epilepsy and the Update Mechanism

“…The majority of patients with refractory epilepsy, which is up to 30% of epilepsy, will suffer a lifetime burden that horrible seizures deteriorate the quality of life with cognitive, psychiatric and (or) other comorbidities [2]. As epilepsy has been regarded as a disease of brain networks, those associated comorbidities, such as cognitive and behavioral comorbidities, psychiatric comorbidities, cardiovascular disease and migraine, are great starting point and refresher for epileptic network [3][4][5][6][7][8]. Unfortunately, the exact underlying etiology of those comorbidities is not clear.…”

Metabolic bone disorders in children with epilepsy

“…Epilepsy is a severe chronic disease, characterized by recurrent seizures and affecting the everyday life of many children as it is the most frequent neurological disease during the childhood [1]. In order to manage and treat this condition, children with epilepsy receive antiepileptic drugs (AEDs), which cause a plethora of behavioral and psychiatric problems.…”