Improved cardiac outcomes with combined atenolol and diazepam intervention in seizure

Abstract

Attenuation of seizure with diazepam offered no cardiac protection; however, coadministration of atenolol with diazepam prevented the development of seizure-induced cardiac dysfunction. This study demonstrates that atenolol intervention should be strongly considered as an adjunct clinical treatment to reduce cardiomyopathy during seizures.

Epilepsy and ultra-structural heart changes: The role of catecholaminergic toxicity and myocardial fibrosis. What can we learn from cardiology?

“…They found a 60% decrease in the myocyte Kv4.2 ion channel, responsible for rapid potassium outflow current related to phase 1 of the membrane's action potential [26]. Beta-blockers used immediately before the seizure [26] or continuously during or after the seizure [27,28], was associated to a reduction in troponin levels, QT interval duration and lethal arrhythmias. We are not aware of studies such as this one in humans.…”

Intramuscular atenolol and levetiracetam reduce mortality in a rat model of paraoxon‐induced status epilepticus

“…There is also evidence that LV can decrease this increased synaptic activity 41,42,44,80,81 and that AT can stabilize the cardiac irritability after SE 32,34,36,82 . Indeed, β‐adrenergic blockade is reported to decrease SE‐induced cardiac pathology and subsequent arrhythmias 32,34–36 . In addition, LV can stabilize synaptic activity and decrease neurotransmitter release in the brain, 33,42,44,81 decrease cardiac manifestations of epilepsy, 50 and minimize neuronal damage following experimental SE 24,25,45 .…”

“…32,34,36,82 Indeed, β-adrenergic blockade is reported to decrease SE-induced cardiac pathology and subsequent arrhythmias. 32,[34][35][36] In addition, LV can stabilize synaptic activity and decrease neurotransmitter release in the brain, 33,42,44,81 decrease cardiac manifestations of epilepsy, 50 and minimize neuronal damage following experimental SE. 24,25,45 In line with these studies, our data here indicate that a combination therapy consisting of the β-blocker AT and the SV inhibitor LV significantly decreased the mortality rate when administered during the first 7-day period following the termination of POX SE.…”

“…34 Subsequently, coadministration of atenolol (AT) along with diazepam following the induction of kainic acid SE was shown to reduce the risk of aconitine-induced arrhythmias. 35 Experimentally, β-adrenergic blockade has proved to be a significant intervention for preventing cardiac dysfunction following SE. 36 Clinically, alterations in cardiac function have an important role in determining SE outcome, and cardiac decompensation is a leading factor in predicting mortality in SE patients.…”

“…Prophylactic treatment with a beta (β)‐adrenergic blocker was demonstrated to be cardioprotective during kainite‐induced SE 34 . Subsequently, coadministration of atenolol (AT) along with diazepam following the induction of kainic acid SE was shown to reduce the risk of aconitine‐induced arrhythmias 35 . Experimentally, β‐adrenergic blockade has proved to be a significant intervention for preventing cardiac dysfunction following SE 36 .…”