Cardiovascular comorbidities in epileptology

Abstract

Epilepsy is one of the most common neurological diseases affecting around 50 million people worldwide. Modern scientific and professional literature recognizes comorbidities as an integral part of epilepsy, with the goal of defining optimal treatment. A series of studies from 2002 to date have confirmed a high prevalence of heart diseases in all age groups of adult patients with epilepsy, and nearly three times higher risk of malignant arrhythmias and sudden cardiac death, compared to the general population. Currently, research is increasingly being focused on elucidating the long-term connection between epilepsy and the cardiovascular system, and in 2020 the term ''epileptic heart'' was first introduced, describing a heart and coronary vasculature damaged by chronic epilepsy. Plausible pathophysiological mechanisms include the cardiotoxic effects of catecholamines and repeated hypoxemia, but also the use of antiseizure medications (ASMs) associated with hyperlipidemia and arrhythmogenic effects, which could make an additional contribution to the electromechanical dysfunction of the heart. People over 60 years of age make up the largest group of patients with newly diagnosed epilepsy and represent a particular challenge for epileptologists, due to the frequent presence of multimorbidity and polypharmacy, especially in the domain of the cardiovascular system. The International League Against Epilepsy (ILAE) Task Force on Epilepsy in the elderly proposed guidelines that state that clinicians need to approach an elderly person as they would a woman of childbearing potential, and emphasize the importance of considering factors such as adverse effects and pharmacokinetic interactions when choosing ASMs, as well as the necessity for an individualized, multidisciplinary and patient-oriented approach. In addition, recent studies draw attention to the need for a routine cardiological assessment when treating patients with epilepsy, and highlight the importance of electrocardiogram (ECG) in determining the initial cardiovascular risk, as well as monitoring the impact of epileptic seizures and ASMs on the structural integrity of the heart and its vasculature.