Mortality in epilepsy

Tomson, Torbjörn

doi:10.1007/s004150050004

Cited by 102 publications

(77 citation statements)

References 47 publications

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“…Epileptic seizures are often associated with autonomic neuronal dysfunction (1), which can contribute, at least in part, to the production of cardiac arrhythmias and can increase the risk of sudden and unexpected death (2,3). Diagnostics and therapeutic improvements to prevent cerebrogenic sudden death will require a better knowledge of epilepsy-evoked arrhythmia.…”

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confidence: 99%

Cardiac Dysrhythmia Associated with the Immediate Postictal State after Maximal Electroshock in Freely Moving Rat

Darbin¹,

Casebeer²,

Naritoku³

2002

Epilepsia

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Summary:Purpose: Cardiac autonomic changes accompany complex partial seizures and generalized tonic-clonic seizures, and participate, at least partially, in the sudden and unexpected death in epilepsy (SUDEP). The analysis of the heart rate variability (HRV) is one of the simplest ways of providing insight into autonomic functions. The entropy quantifies the repetition of complex patterns in a signal and refers to systems randomness, regularity, and predictability. Clinical investigations have reported that entropy decreases in patients with a high risk of sudden cardiac death. The goal of this study was to evaluate the effects of the maximal electroshock (MES) on the entropy of HRV, monitored in the immediate postictal stage in the model of the freely moving rat.Methods: Entropy changes were correlated with the high and low frequencies of spectral analysis, which reflect the participation of the sympathetic and parasympathetic activities.Results: MES-induced arrhythmia is characterized by an HRV increase, an imbalance in favor of the parasympathetic activity, and a decrease in the entropy. Entropy decrease was restricted to the duration of the arrhythmia, suggesting that the postictal arrhythmia may be associated with a higher risk of lethal cardiac complications. Nevertheless, entropy changes did not correlate with spectral changes.Conclusions: The results suggest that the imbalance demonstrated in the spectral domain explains only partially the contribution of each autonomic system in the complexity of the heart rate during the postictal state. Key Words: EpilepsyHeart rate variability-Entropy-Sudden unexpected death.Epileptic seizures are often associated with autonomic neuronal dysfunction (1), which can contribute, at least in part, to the production of cardiac arrhythmias and can increase the risk of sudden and unexpected death (2,3). Diagnostics and therapeutic improvements to prevent cerebrogenic sudden death will require a better knowledge of epilepsy-evoked arrhythmia. Cardiac autonomic changes accompany complex partial seizures and generalized tonic-clonic seizures (4,5). Electroconvulsive seizures in the cat (6) are known to induce cardiac arrhythmia, linked in part to a mixed autonomic syndrome characterized mainly by a parasympathetic component.The analysis of the heart rate variability (HRV) is relevant in neurocardiology, and it is one of the simplest ways of providing insight into autonomic functions in both patients and laboratory animals. HRV is related the variability of adjacent beat-to-beat intervals. HRV is quantified by the calculation of the standard deviation (SD). In addition to the SD, which is one of the parameters included in the time domain analysis, the frequency analysis of changes in successive beat-to-beat intervals has been proposed to evaluate the relative contribution of the sympathetic and the parasympathetic activity. The high-frequency (HF) component is attributed to vagal mechanisms (6), and the low frequency (LF) component is attributed to sympathetic activities or joi...

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confidence: 99%

Cardiac Dysrhythmia Associated with the Immediate Postictal State after Maximal Electroshock in Freely Moving Rat

Darbin¹,

Casebeer²,

Naritoku³

2002

Epilepsia

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“…Estudos baseados em comunidades e de populações mais selecionadas consistentemente revelam que as pessoas com epilepsia têm mortalidade duas a três vezes superior à da população geral (Tomson, 2000). A redução ou remissão de crises epilépticas através de tratamento adequado com DAE ou cirúrgico é uma das medidas propostas para a redução desta mortalidade (Sander e Bell, 2004).…”

Section: Relevância Da Epilepsia Como Problema De Saúde Públicaunclassified

“…Os transtornos mentais associados à epilepsia são tradicionalmente divididos em periictais e interictais (Marchetti e Damasceno, 2000;Falret, 1860;Toone, 1981;Mendez, 1995;Sachdev, 1998). A característica principal dos transtornos mentais periictais é a relação temporal estreita entre estes e as crises epilépticas, ocorrendo imediatamente antes, durante ou depois delas.…”

Section: Classificação Dos Transtornos Mentais Associados à Epilepsiaunclassified

Transtornos mentais associados à epilepsia

Marchetti

Castro

Kurcgant³

et al. 2005

Rev. psiquiatr. clín.

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ResumoEpilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mundo, 40 milhões delas em países em desenvolvimento. Embora seja um problema predominantemente tratável, nestes países a maioria dos pacientes permanece sem tratamento. Provavelmente uma das principais causas para isto seja o estigma que atinge as pessoas com epilepsia. Tal fato se agrava ainda mais quando à epilepsia se associam transtornos mentais, que ocorrem com prevalência aumentada. Os pacientes com epilepsia e transtornos mentais sofrem o que se chama de "duplo estigma", que freqüentemente os deixa sem tratamento. É provável, particularmente em países em desenvolvimento, que psiquiatras se defrontem com pacientes com epilepsia nos diferentes locais de atendimento. Os autores revisam diferentes aspectos dos principais transtornos mentais associados à epilepsia.Palavras-chave: Epilepsia, transtornos mentais, transtornos psicóticos, transtornos depressivos, crises não-epilépticas psicogênicas. AbstractEpilepsy is the most common serious neurological disorder. Worldwide, around 50 million people have epilepsy, 40 million of which in developing countries. Though epilepsy is predominantly treatable, most patients in these countries remain without treatment. It is likely that one of the main reasons is the stigma associated with epilepsy. This problem increases when mental disorders are associated with epilepsy, a fairly frequent occurrence. Patients with epilepsy and mental disorders are exposed to a "double stigma", which frequently leads to complete absence of treatment. It is probable that, particularly in developing countries, psychiatrists will be involved with the treatment of people with epilepsy. The authors review different aspects of the most important mental disorders associated with epilepsy.

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“…People with epilepsy have a mortality rate 2-3 times higher than that of the general population (Tomson, 2000). Higher mortality is related to the underlying disorder causing epilepsy or to death as a direct consequence of seizures (accidents, status epilepticus, and sudden unexpected death) (Mohanraj et al, 2006).…”

Section: Introductionmentioning

confidence: 99%