Echocardiographic risk markers of sudden death in patients with temporal lobe epilepsy

Fialho, Guilherme Loureiro; Pagani, Arthur G.; Wolf, Peter; Walz, Roger; Lin, Kátia

doi:10.1016/j.eplepsyres.2018.01.016

Cited by 31 publications

(35 citation statements)

References 31 publications

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“…Fibrosis per se is related to worse cardiovascular outcomes and sudden death as seen in different populations with heart failure, cardiomyopathy, and ischemic heart disease . To the best of our knowledge, our group was the first to report increased stiffness in PWE …”

Section: Discussionmentioning

confidence: 77%

“…A full echocardiography examination, measuring cardiac size and function (systolic and diastolic) was performed as described earlier …”

Section: Methodsmentioning

confidence: 99%

“…Echocardiography and treadmill testing are widely used in cardiology to analyze structural and functional heart changes and also autonomic response to exercise; these factors have impact on outcomes such as sudden and all‐cause death . Subtle changes in cardiac stiffness are measurable by echocardiography and have also been described in PWE as we discussed in a previous paper …”

Section: Introductionmentioning

confidence: 93%

“…A full echocardiography examination, measuring cardiac size and function (systolic and diastolic) was performed as described earlier. 8 Noninvasive estimation of the left ventricular end-diastolic pressure-volume relationship (LVEDPVR) and stiffness constant, b, was measured by the method described by Klotz et al 6 Briefly, LVEDPVR can be predicted by calculating the volume (LVEDV) at which pressure is 0 mm Hg {V 0 = LVEDV 9 [0.6-(0.006 9 DP)]} and volume at which pressure is equal to 30 mm Hg…”

Section: Echocardiographymentioning

confidence: 99%

“…5 Subtle changes in cardiac stiffness are measurable by echocardiography 6,7 and have also been described in PWE as we discussed in a previous paper. 8 Our present goal was to evaluate cardiac stiffness by echocardiography, a noninvasive marker of cardiac fibrosis, and its association with clinical, structural, and autonomic variables in PWE compared to healthy controls. Our hypothesis was that subtle heart abnormalities related to cardiac stiffness were more prevalent in TLE patients, compared to controls, and could be related to autonomic dysfunction and epilepsy-related variables.…”

Section: Introductionmentioning

confidence: 99%

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Increased cardiac stiffness is associated with autonomic dysfunction in patients with temporal lobe epilepsy

et al. 2018

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Autonomic dysfunction is linked to sudden death regardless of the presence of structural heart disease. The pathway from autonomic dysfunction to sudden death is not fully understood, but myocardial sympathetic stimulation leading to arrhythmia and/or cardiac fibrosis might play a role. Our goal was to evaluate cardiac stiffness by echocardiography and its association with clinical, structural, and autonomic variables in people with epilepsy (PWE) compared to healthy controls. A 12-lead electrocardiogram, treadmill testing, and transthoracic echocardiography from 30 patients with temporal lobe epilepsy (TLE) without any known cardiovascular disorders were compared to 30 individuals without epilepsy matched by sex, age, and body mass index. Distribution of cardiovascular risk factors was similar in both groups. PWE had a higher left ventricle stiffness, left ventricle filling pressure, and greater left atrial volume as well as markers of autonomic dysfunction such as impaired chronotropic index and percentage achieved of predicted peak heart rate at effort. In multiple regressions, autonomic dysfunction explained 52% of stiffness and carbamazepine treatment and polytherapy with antiepileptic drugs (AEDs) explained, additionally, 6% each. Stiffness is increased in young patients with TLE and is related to autonomic dysfunction and to a lesser extent, carbamazepine use and polytherapy with AEDs.

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Section: Discussionmentioning

confidence: 77%

“…A full echocardiography examination, measuring cardiac size and function (systolic and diastolic) was performed as described earlier …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Echocardiographymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increased cardiac stiffness is associated with autonomic dysfunction in patients with temporal lobe epilepsy

et al. 2018

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Cardiac Investigations in Sudden Unexpected Death in DEPDC5‐Related Epilepsy

Bacq¹,

Roussel²,

Bonduelle³

et al. 2021

Annals of Neurology

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Objective: Germline loss-of-function mutations in DEPDC5, and in its binding partners (NPRL2/3) of the mammalian target of rapamycin (mTOR) repressor GATOR1 complex, cause focal epilepsies and increase the risk of sudden unexpected death in epilepsy (SUDEP). Here, we asked whether DEPDC5 haploinsufficiency predisposes to primary cardiac defects that could contribute to SUDEP and therefore impact the clinical management of patients at high risk of SUDEP. Methods: Clinical cardiac investigations were performed in 16 patients with pathogenic variants in DEPDC5, NPRL2, or NPRL3. Two novel Depdc5 mouse strains, a human HA-tagged Depdc5 strain and a Depdc5 heterozygous knockout with a neuron-specific deletion of the second allele (Depdc5 c/À ), were generated to investigate the role of Depdc5 in SUDEP and cardiac activity during seizures. Results: Holter, echocardiographic, and electrocardiographic (ECG) examinations provided no evidence for altered clinical cardiac function in the patient cohort, of whom 3 DEPDC5 patients succumbed to SUDEP and 6 had a family history of SUDEP. There was no cardiac injury at autopsy in a postmortem DEPDC5 SUDEP case. The HA-tagged Depdc5 mouse revealed expression of Depdc5 in the brain, heart, and lungs. Simultaneous electroencephalographic-ECG records on Depdc5 c/À mice showed that spontaneous epileptic seizures resulting in a SUDEP-like event are not preceded by cardiac arrhythmia. Interpretation: Mouse and human data show neither structural nor functional cardiac damage that might underlie a primary contribution to SUDEP in the spectrum of DEPDC5-related epilepsies.

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Cardiorespiratory findings in epilepsy: A recent review on outcomes and pathophysiology

Akyüz

Uner

Köklü

et al. 2021

J of Neuroscience Research

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Epilepsy is a debilitating disorder of uncontrollable recurrent seizures that occurs as a result of imbalances in the brain excitatory and inhibitory neuronal signals, that could stem from a range of functional and structural neuronal impairments. Globally, nearly 70 million people are negatively impacted by epilepsy and its comorbidities. One such comorbidity is the effect epilepsy has on the autonomic nervous system (ANS), which plays a role in the control of blood circulation, respiration and gastrointestinal function. These epilepsy‐induced impairments in the circulatory and respiratory systems may contribute toward sudden unexpected death in epilepsy (SUDEP). Although, various hypotheses have been proposed regarding the role of epilepsy on ANS, the linking pathological mechanism still remains unclear. Channelopathies and seizure‐induced damages in ANS‐control brain structures were some of the causal/pathological candidates of cardiorespiratory comorbidities in epilepsy patients, especially in those who were drug resistant. However, emerging preclinical research suggest that neurotransmitter/receptor dysfunction and synaptic changes in the ANS may also contribute to the epilepsy‐related autonomic disorders. Thus, pathological mechanisms of cardiorespiratory dysfunction should be elucidated by considering the modifications in anatomy and physiology of the autonomic system caused by seizures. In this regard, we present a comprehensive review of the current literature, both clinical and preclinical animal studies, on the cardiorespiratory findings in epilepsy and elucidate the possible pathological mechanisms of these findings, in hopes to prevent SUDEP especially in patients who are drug resistant.

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Echocardiographic risk markers of sudden death in patients with temporal lobe epilepsy

Cited by 31 publications

References 31 publications

Increased cardiac stiffness is associated with autonomic dysfunction in patients with temporal lobe epilepsy

Increased cardiac stiffness is associated with autonomic dysfunction in patients with temporal lobe epilepsy

Cardiac Investigations in Sudden Unexpected Death in DEPDC5‐Related Epilepsy

Cardiorespiratory findings in epilepsy: A recent review on outcomes and pathophysiology

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