Maximal/exhaustive treadmill test features in patients with temporal lobe epilepsy: Search for sudden unexpected death biomarkers

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

doi:10.1016/j.eplepsyres.2017.04.014

Cited by 21 publications

(41 citation statements)

References 38 publications

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“…Treadmill variables were significantly worse in TLE patients compared to controls . Peak heart rate (164 ± 21.3 vs 181 ± 12.5 bpm), exercise duration (673.6 ± 148.3 vs 784.4 ± 155.72 seconds), percentage achieved of predicted peak heart rate (89.6% ± 9.4% vs 98% ± 5.3%), and chronotropic index (82.6% ± 14.9% vs 96.7% ± 9.7%) were lower in PWE.…”

Section: Resultsmentioning

confidence: 80%

“…Hippocampal sclerosis was present in 58.1% of patients (bilateral lesion was found in 13.3%, whereas right and left lesions occurred in 43.3%, respectively). Demographic and clinical variables were described previously elsewhere . In summary, age (37.4 ± 11.2 vs 35.3 ± 9.3), gender (60% male in both groups), BMI (25.6 ± 5.1 vs 25.5 ± 4.1), and cardiovascular risk factors, such as diabetes (10% vs 0%), hypertension (6.7% in both groups), dyslipidemia (20% vs 16.7%), smoking habit (20% vs 16.7%), sedentary lifestyle (56.7% vs 36.7%), and first‐degree family history of cardiovascular disease (20% vs 23.3%) were similar between PWE and controls ( P > .05).…”

Section: Resultsmentioning

confidence: 99%

“…Autonomic dysfunction is prevalent in PWE and also in patients with heart failure with preserved ejection fraction (HFpEF) . We recently demonstrated that the percentage achieved of the predicted peak heart rate and chronotropic index was related to age of onset of epilepsy and number of monthly bilateral tonic–clonic seizures . In a rat model, autonomic dysfunction, with increased sympathetic drive and lower parasympathetic activity, was related to modification of the calcium handling in cardiac myocytes, leading to increased stiffness …”

Section: Discussionmentioning

confidence: 99%

“…The enrollment criteria were described previously . Briefly, we included patients with a definite diagnosis of temporal lobe epilepsy (TLE) followed at the Comprehensive Epilepsy Center at the University Hospital of Santa Catarina, Brazil, between July 2015 and July 2016 .…”

Section: Methodsmentioning

confidence: 99%

“…People with epilepsy (PWE) have an increased risk of sudden unexpected death in epilepsy (SUDEP) compared to the general population, and SUDEP is responsible for up to 15% of all epilepsy‐related deaths . Interictal autonomic dysfunction has been associated with epilepsy …”

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: Resultsmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

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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Sudden unexpected death in epilepsy: A critical view of the literature

et al. 2023

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Sudden unexpected death in epilepsy (SUDEP) is a sudden, unexpected, witnessed or unwitnessed, non‐traumatic and non‐drowning death, occurring in benign circumstances, in an individual with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus in which postmortem examination does not reveal other causes of death. Lower diagnostic levels are assigned when cases met most or all of these criteria, but data suggested more than one possible cause of death. The incidence of SUDEP ranged from 0.09 to 2.4 per 1000 person‐years. Differences can be attributed to the age of the study populations (with peaks in the 20–40‐year age group) and the severity of the disease. Young age, disease severity (in particular, a history of generalized TCS), having symptomatic epilepsy, and the response to antiseizure medications (ASMs) are possible independent predictors of SUDEP. The pathophysiological mechanisms are not fully known due to the limited data available and because SUDEP is not always witnessed and has been electrophysiologically monitored only in a few cases with simultaneous assessment of respiratory, cardiac, and brain activity. The pathophysiological basis of SUDEP may vary according to different circumstances that make that particular seizure, in that specific moment and in that patient, a fatal event. The main hypothesized mechanisms, which could contribute to a cascade of events, are cardiac dysfunction (included potential effects of ASMs, genetically determined channelopathies, acquired heart diseases), respiratory dysfunction (included postictal arousal deficit for the respiratory mechanism, acquired respiratory diseases), neuromodulator dysfunction, postictal EEG depression and genetic factors.

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AMPAr GluA1 Phosphorylation at Serine 845 in Limbic System Is Associated with Cardiac Autonomic Tone

et al. 2021

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Maximal/exhaustive treadmill test features in patients with temporal lobe epilepsy: Search for sudden unexpected death biomarkers

Cited by 21 publications

References 38 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

Sudden unexpected death in epilepsy: A critical view of the literature

AMPAr GluA1 Phosphorylation at Serine 845 in Limbic System Is Associated with Cardiac Autonomic Tone

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