The Insula and Cerebrogenic Sudden Death

Cheung, Raymond Tak Fai; Hachinski, Vladimir

doi:10.1001/archneur.57.12.1685

Cited by 190 publications

(143 citation statements)

References 23 publications

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“…Importantly, the link between both the FSS subscales and fast insular stress responses remained significant under these circumstances. These findings clearly argue that the link between disability and activity must be driven by further processes in addition to fatigue, an assumption that is consistent with other immunity-related processes regulated by the insula such as autonomic nervous system activity (36).…”

Section: Discussionsupporting

confidence: 81%

Stress-induced brain activity, brain atrophy, and clinical disability in multiple sclerosis

Weygandt

Meyer-Arndt

Behrens

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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Prospective clinical studies support a link between psychological stress and multiple sclerosis (MS) disease severity, and peripheral stress systems are frequently dysregulated in MS patients. However, the exact link between neurobiological stress systems and MS symptoms is unknown. To evaluate the link between neural stress responses and disease parameters, we used an arterial-spin-labeling functional MRI stress paradigm in 36 MS patients and 21 healthy controls. Specifically, we measured brain activity during a mental arithmetic paradigm with performance-adaptive task frequency and performance feedback and related this activity to disease parameters. Across all participants, stress increased heart rate, perceived stress, and neural activity in the visual, cerebellar and insular cortex areas compared with a resting condition. None of these responses was related to cognitive load (task frequency). Consistently, although performance and cognitive load were lower in patients than in controls, stress responses did not differ between groups. Insula activity elevated during stress compared with rest was negatively linked to impairment of pyramidal and cerebral functions in patients. Cerebellar activation was related negatively to gray matter (GM) atrophy (i.e., positively to GM volume) in patients. Interestingly, this link was also observed in overlapping areas in controls. Cognitive load did not contribute to these associations. The results show that our task induced psychological stress independent of cognitive load. Moreover, stress-induced brain activity reflects clinical disability in MS. Finally, the link between stress-induced activity and GM volume in patients and controls in overlapping areas suggests that this link cannot be caused by the disease alone.multiple sclerosis | psychological stress | functional magnetic resonance imaging | clinical disability | brain atrophy M ultiple sclerosis (MS) is an autoimmune disease of the central nervous system leading to demyelination, axonal damage. and neuronal degeneration (1). In addition to sensorimotor symptoms, stress-related syndromes such as depression and anxiety disorders are among the most frequent comorbidities in MS (2).A role for psychological stress in the pathobiology of MS was hypothesized as early as the 19th century when Charcot first described the disease, and a link between stress and the risk of MS relapse is now supported by numerous prospective clinical studies (e.g., 3). Moreover, MS patients frequently exhibit dysregulated psychobiological stress systems, and these systems interact with the key neurologic characteristics. Neuroendocrine studies revealed a link between MS and altered regulation of both stress systems, the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS) (4). Specifically, pharmacological challenge tests have shown that glucocorticoid responsivity is elevated in MS patients (5) and that impaired HPA axis feedback control is linked to brain atrophy (6) and subsequent deterioration of clinical di...

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Section: Discussionsupporting

confidence: 81%

Stress-induced brain activity, brain atrophy, and clinical disability in multiple sclerosis

Weygandt

Meyer-Arndt

Behrens

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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“…25 Of note, the coronary microcirculation is innervated by neurons that originate in the brain stem and mediate vasoconstriction, which supports the concept that myocardial stunning due to microvascular dysfunction among patients with takotsubo cardiomyopathy 26 may be of neurogenic origin. 27 Consistently, histopathological findings in cardiac tissue samples obtained from patients with sudden unexpected death during epilepsy or subarachnoid hemorrhage strongly resembled those of patients who died during an episode of takotsubo cardiomyopathy. 5,28 Patients with takotsubo cardiomyopathy are more likely to present with neurologic and psychiatric disorders than are patients with an acute coronary syndrome.…”

Section: Discussionmentioning

confidence: 52%

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Templin¹,

et al. 2015

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BACKGROUND The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. METHODS The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age-and sex-matched patients who had an acute coronary syndrome. RESULTS Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. CONCLUSIONS Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).

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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.…”

mentioning

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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The Insula and Cerebrogenic Sudden Death

Cited by 190 publications

References 23 publications

Stress-induced brain activity, brain atrophy, and clinical disability in multiple sclerosis

Stress-induced brain activity, brain atrophy, and clinical disability in multiple sclerosis

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

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

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