Monitoring peri-ictal changes in heart rate variability, oxygen saturation and blood pressure in epilepsy monitoring unit

Jaychandran, R; Chaitanya, Ganne; Satishchandra, Parthasarathy; Bharath, R D; Thennarasu, K; Sinha, Sukanto

doi:10.1016/j.eplepsyres.2016.05.013

Cited by 34 publications

(48 citation statements)

References 44 publications

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“…Potential explanations for seizure‐induced subconjunctival haemorrhage would include trauma during the seizure or seizure‐induced hypertension (Jaychandran et al . ).…”

Section: Discussionmentioning

confidence: 97%

Subconjunctival haemorrhage in 147 dogs

Saastamoinen

Rutter

Jeffery

2019

J of Small Animal Practice

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Objectives To identify differential diagnoses for subconjunctival haemorrhage in dogs. Materials and Methods Retrospective case series. Results Of 147 dogs with subconjunctival haemorrhage, 119 had a history of trauma. The most common types of injury were vehicular trauma (47/119) and dog attacks (32/119). Confirmed or suspected non‐accidental injury was reported for 5/119. Of the 28 dogs without a history of trauma, 13 had a bleeding disorder and of these, immune‐mediated thrombocytopenia was the most common diagnosis (9/13). Other causes included seizure disorders (4/28), vasculitis (3/28) and ocular or periocular disease (3/28). Clinical Significance Subconjunctival haemorrhage in dogs can be secondary to a wide range of injuries and systemic diseases, bleeding diathesis or ocular disease.

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“…Potential explanations for seizure‐induced subconjunctival haemorrhage would include trauma during the seizure or seizure‐induced hypertension (Jaychandran et al . ).…”

Section: Discussionmentioning

confidence: 97%

Subconjunctival haemorrhage in 147 dogs

Saastamoinen

Rutter

Jeffery

2019

J of Small Animal Practice

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“…Periictal changes in HRV have been extensively studied and partially depend on seizure type. In general, HRV decreases during the ictal phase, gradually returning to baseline in the postictal period . However, a patient who aspirates during a seizure might also have a sudden increase in HRV when vagal tone increases during the act of coughing or choking.…”

Section: Discussionmentioning

confidence: 99%

“…In general, HRV decreases during the ictal phase, gradually returning to baseline in the postictal period. [28][29][30][31] However, a patient who aspirates during a F I G U R E 2 Hypothetical model of autonomic "second hit" sudden unexpected death in epilepsy (SUDEP) mechanism. Diurnal variation in heart rate variability (HRV) is based on data from this study as well as previous studies.…”

Section: Sudep Pathophysiologymentioning

confidence: 99%

Heart rate variability in epilepsy: A potential biomarker of sudden unexpected death in epilepsy risk

et al. 2018

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These findings suggest that autonomic dysfunction is associated with SUDEP risk in patients with epilepsy due to sodium channel mutations. The relationship of HRV to SUDEP merits further study; HRV may eventually have potential as a biomarker of SUDEP risk, which would allow for more informed counseling of patients and families, and also serve as a useful outcome measure for research aimed at developing therapies and interventions to reduce SUDEP risk.

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“…Abnormal autonomic output to the heart may represent an important mediator of cardiac dysfunction in epilepsy. Tachycardic and hypertensive responses accompanied more than 25% of seizures in one video‐EEG monitoring unit, although less common bradycardia and hypotension also occurred . Indeed, analysis of heart rate variability during seizures revealed evidence of both increased sympathetic and decreased parasympathetic activity .…”

Section: Pathophysiology Of Altered Cardiac Ion Channel Expression Inmentioning

confidence: 99%

“…Seizure activity originating from or spreading to cortical (eg, insula and prefrontal cortex) and limbic (eg, hypothalamus, amygdala, cingulate, and peri‐aqueductal gray) regulators of brainstem autonomic output may be responsible . These structures lie either within or in proximity to the temporal lobe, which could explain why temporal seizures are associated with ictal tachycardia . Accordingly, ECG markers of autonomic dysfunction during temporal seizures correlate with electrical activity in the hypothalamus and amygdala .…”

Section: Pathophysiology Of Altered Cardiac Ion Channel Expression Inmentioning

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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Monitoring peri-ictal changes in heart rate variability, oxygen saturation and blood pressure in epilepsy monitoring unit

Cited by 34 publications

References 44 publications

Subconjunctival haemorrhage in 147 dogs

Subconjunctival haemorrhage in 147 dogs

Heart rate variability in epilepsy: A potential biomarker of sudden unexpected death in epilepsy risk

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

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