Резюме Цель-изучение группы взрослых пациентов с фокальной эпилепсией и установленными иктальными нарушениями сердечного ритма и проводимости с учетом нозологических, анамнестических, клинических, электроэнцефалографических и нейровизуализационных особенностей. Материалы и методы. В исследование было отобрано 70 пациентов в возрасте от 18 лет до 51 года с подтвержденным диагнозом фокальная эпилепсия с сохраняющимися на момент исследования эпилептическими приступами на фоне проводимой противоэпилептической терапии без сопутствующей кардиальной патологии с установленными иктальными изменениями сердечного ритма и проводимости. Результаты. Среди обследованных больных преобладали пациенты с диагнозом «структурная фокальная эпилепсия», длительным течением заболевания, с частыми эпилептическими приступами, с височной и лобно-височной локализацией эпилептогенного очага, принимающие несколько противоэпилептических препаратов. Наиболее часто нарушения сердечного ритма и проводимости возникали у мужчин, с серийным течением пароксизмов, с билатеральными тонико-клоническими приступами, с приступами, возникающими во время сна. Заключение. Своевременное выявление и обследование пациентов из групп высокого риска по иктальным аритмиям позволит предотвратить развитие нарушений ритма и проводимости сердца во время развития эпилептических приступов, в том числе жизнеугрожающего характера. Ключевые слова Фокальная эпилепсия, эпилептические приступы, видео-ЭЭГ-мониторинг, противоэпилептические препараты, нарушения сердечного ритма и проводимости. Оригинальные статьи 15 Эпилепсия и пароксизмальные состояния www.epilepsia.su
Purpose Epileptic seizures may cause severe cardiac arrhythmias. Most people with epilepsy die suddenly and whose death is recognized to a sudden unexpected death in epilepsy (SUDEP). There are controversial reports on the association between polytherapy using antiepileptic drugs and SUDEP. First-line drugs include, in particular, carbamazepine, oxcarbazepine, and lamotrigine, which are sodium channel blockers that may impair heart function. Often a patient requires a combination of antiepileptic drugs Methods 204 patients with epilepsy and were on antiepileptic drugs therapy. The ECG cardiac monitor was implanted in all patients (n=204) and was analyzed together with the preclinical data including age, sex, family history, cardiac risk factors (hypertension, dyslipidemia, diabetes mellitus), heart disease, antiepileptic drug type. Results After a follow-up of 12-month ictal ECG changes (rhythm and conduction disturbances, ST segment abnormalities) were observed in 134 (66%) patients, and only in 70 (34%) – without ictal ECG changes, the average age in these groups was 34,4±9,9 and 36,7±11,8 years (p>0,05). In the group with ictal ECG changes among patients receiving as monotherapy antiepileptic drugs, ictal ECG changes were found in 53.7% of cases, with polytherapy antiepileptic drugs significantly more often – in 71.5% of cases (p<0.05). a reliable association between carbamazepine and changes in sinoatrial and atrioventricular conduction (p=0.01) was significant. In the analyzed group of patients, carbamazepine therapy was also associated with the presence of ictal ST-segment abnormalities (depression/elevation) (p=0.013). A positive association was observed between the administration of oxcarbazepine and development of ictal tachycardia (p=0.04) and ictal right and left bundle branch block, which was observed in 71.4% of cases against the background of oxcarbazepine, significantly more often than with other drugs (p=0.005). Conclusion In agreement with previous publications available in the literature, our results confirm the risk of high-frequency rhythm and conduction disturbances, ST segment abnormalities related to antiepileptic drugs, in particular, carbamazepine and oxcarbazepine and indicates the need of not only cardiological examination before prescribing an antiepileptic drugs, but also a thorough follow-up during the therapy. Patients with ictal ECG changes, primarily rhythm and conduction disturbances, should be under the dynamic control of not only neurologists but also cardiologists and require regular cardiological check-up (ECG, Holter monitoring of the electrocardiogram, echocardiography). Funding Acknowledgement Type of funding source: None
Background Events of ictal bradycardia or asystole may be of importance in epilepsy patients showing with ictal falls and are a funder to SUDEP. With using implantable loop recorders, we can detect ictal bradycardia or asystole. And implantation of cardiac pacemakers may prevent life-threatening syncope, cardiac arrest, and disturbances. Purpose The purpose of this study is to look at how many ictal bradycardia or asystole and match with localization, types of seizure and antiepileptic drugs in a patient with hard to treat epilepsy. Methods Patients with hard to treat epilepsy were implanted loop recorders. Patients or their relations were activated loop recorder (with a special patient assistant) during or after seizure depending on the type of seizure. Results 204 patients included in the study. The mean duration of loop recording 24 months. 1168 ECG seizure were reordered of 204 patients, 494 (42%) secondary generalized seizures and 674 (58%) partial seizures. Nine patients (4%) were recorded ictal bradycardia and ictal asystole. Only four patients with ictal asystole and bradycardia take AED (antiepileptic drug) inhibit sodium channels. During seizure were recorded only 14 (1, 1%) seizure with ictal asystole and bradycardia of nine patients, 6 (42%) – with ictal asystole (5 – SA-block, 1 – AV-block), 8 (57%) – ictal bradycardia. Ten (71%) events of 14 was secondary generalized seizures, 4 (28%) - partial seizures. Five ictal asystoles recorded during secondarily generalized seizures, and only 1 partial seizure. Five ictal bradycardias reordered during secondarily generalized seizures, 3 - partial seizure. Frontal-temporal localization only 4 patients, 1 – occipital-frontal, 1 – frontal, 3 – without consistent epilepsy localization. Three patients with bilateral lateralization, 2 – left lateralization, 1 – right lateralization, 3 – without consistent epilepsy lateralization. Conclusions Ictal asystole can be problematic to diagnose because of both its under-recognition and its appearance only during seizures. In this study, we showed the most life-threatening events occurred in patients with the secondarily generalized seizures. Bradyarrhythmias can one of possible sudden unexplained death in epilepsy patients (SUDEP). No clear association was seen between ictal bradycardia/asystole and lateralization or localization of seizure onset.
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