Interictal cardiac repolarization abnormalities in people with epilepsy

Kishk, Nirmeen A.; Sharaf, Yasser; Ebraheim, Asmaa M.; Baghdady, Yasser; Alieldin, Nelly; Afify, Ahmed; El-Damaty, Ahmed

doi:10.1016/j.yebeh.2017.10.028

Cited by 20 publications

(23 citation statements)

References 45 publications

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“…Cardiac electrical disturbances have been identified in patients with epilepsy [35]. In a study, older age and poor seizure control had a statistically significant higher effect on QTc prolongation in the group with epilepsy [36]. Conversely, we could not have identified any rhythm problem.…”

Section: Discussionmentioning

confidence: 61%

Left ventricular myocardial deformation abnormalities in seizure-free children with epilepsy

Çelik

Güven

Torun

2018

Seizure

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Section: Discussionmentioning

confidence: 61%

Left ventricular myocardial deformation abnormalities in seizure-free children with epilepsy

Çelik

Güven

Torun

2018

Seizure

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“…Aside from periictal abnormalities, interictal observations reveal a baseline level of persistent cardiac dysfunction among individuals with epilepsy. As with ictal studies, interictal prolongation of the QTc interval has been reported, especially among individuals with poor seizure control . Elevated sympathetic tone and decreased parasympathetic tone are also evident upon interrogation of heart rate variability, with a more severe dysautonomia noted in cases of SUDEP .…”

Section: Introductionmentioning

confidence: 90%

“…As with ictal studies, interictal prolongation of the QTc interval has been reported, especially among individuals with poor seizure control. 6 Elevated sympathetic tone and decreased parasympathetic tone are also evident upon interrogation of heart rate variability, with a more severe dysautonomia noted in cases of SUDEP. 7,8 Furthermore, echocardiographic features of systolic and diastolic dysfunction highlight the functional consequences of myocardial damage secondary to repetitive ictal activity.…”

Section: Introductionmentioning

confidence: 99%

Acquired cardiac channelopathies in epilepsy: Evidence, mechanisms, and clinical significance

O’Brien

Todaro

et al. 2019

Epilepsia

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There is growing evidence that cardiac dysfunction in patients with chronic epilepsy could play a pathogenic role in sudden unexpected death in epilepsy (SUDEP). Recent animal studies have revealed that epilepsy secondarily alters the expression of cardiac ion channels alongside abnormal cardiac electrophysiology and remodeling. These molecular findings represent novel evidence for an acquired cardiac channelopathy in epilepsy, distinct from inherited ion channels mutations associated with cardiocerebral phenotypes. Specifically, seizure activity has been shown to alter the messenger RNA (mRNA) and protein expression of voltage‐gated sodium channels (Nav1.1, Nav1.5), voltage‐gated potassium channels (Kv4.2, Kv4.3), sodium‐calcium exchangers (NCX1), and nonspecific cation‐conducting channels (HCN2, HCN4). The pathophysiology may involve autonomic dysfunction and structural cardiac disease, as both are independently associated with epilepsy and ion channel dysregulation. Indeed, in vivo and in vitro studies of cardiac pathology reveal a complex network of signaling pathways and transcription factors regulating ion channel expression in the setting of sympathetic overactivity, cardiac failure, and hypertrophy. Other mechanisms such as circulating inflammatory mediators or exogenous effects of antiepileptic medications lack evidence. Moreover, an acquired cardiac channelopathy may underlie the electrophysiologic cardiac abnormalities seen in chronic epilepsy, potentially contributing to the increased risk of malignant arrhythmias and sudden death. Therefore, further investigation is necessary to establish whether cardiac ion channel dysregulation similarly occurs in patients with epilepsy, and to characterize any pathogenic relationship with SUDEP.

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“…In the ED, his BP remained elevated at 209/137 and he was mildly confused and agitated, presumed due to postictal state. He had a GCS of 15 touch, and no focal neurological deficits. He received multiple doses of lorazepam in the ED to combat seizure activity and was intubated for airway protection.…”

Section: Case Presentationmentioning

confidence: 99%

“…Additional workup of seizures includes blood work to evaluate metabolic and thyroid issues and ECG and lumbar puncture to rule out hypoxic cerebral injury from syncope and infectious processes, respectively. 7,14,15 Although there were some abnormalities in his laboratory results, there was nothing evident as the cause of his seizures (Table 1). ECGs were done on our patient and were insignificant.…”

Section: Treatmentmentioning

confidence: 99%

Hypertensive emergency and seizures in a 30‐year‐old man with anti–glomerular basement membrane disease

Mascola

Karmali

Mathews³

et al. 2020

Clinical Case Reports

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Interictal cardiac repolarization abnormalities in people with epilepsy

Cited by 20 publications

References 45 publications

Left ventricular myocardial deformation abnormalities in seizure-free children with epilepsy

Left ventricular myocardial deformation abnormalities in seizure-free children with epilepsy

Acquired cardiac channelopathies in epilepsy: Evidence, mechanisms, and clinical significance

Hypertensive emergency and seizures in a 30‐year‐old man with anti–glomerular basement membrane disease

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