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Scorza FA. Breaking bad news on the possible occurrence of sudden death in children with epilepsy sleeping on sofas. Epilepsy Behav 2015; 50:88-9. [PMID: 26149063 DOI: 10.1016/j.yebeh.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Departamento de Neurologia/Neurocirurgia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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152
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Autonomic changes following generalized tonic clonic seizures: An analysis of adult and pediatric patients with epilepsy. Epilepsy Res 2015. [DOI: 10.1016/j.eplepsyres.2015.06.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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153
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Read MI, Harrison JC, Kerr DS, Sammut IA. Atenolol offers better protection than clonidine against cardiac injury in kainic acid-induced status epilepticus. Br J Pharmacol 2015; 172:4626-38. [PMID: 25765931 DOI: 10.1111/bph.13132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 02/21/2015] [Accepted: 03/06/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE Status epilepticus is increasingly associated with cardiac injury in both clinical and animal studies. The current study examined ECG activity for up to 48 h following kainic acid (KA) seizure induction and compared the potential of atenolol and clonidine to attenuate this cardiac pathology. EXPERIMENTAL APPROACH Sprague-Dawley rats (male, 300-350 g) were implanted with ECG and electrocorticogram electrodes to allow simultaneous telemetric recordings of cardiac and cortical responses during and after KA-induced seizures. Animals were randomized into saline controls, and saline vehicle-, clonidine- or atenolol-pretreated KA groups. KEY RESULTS KA administration in the saline-pretreated group produced an immediate bradycardic response (maximal decrease of 28 ± 6%), coinciding with low-level seizure activity. As high-level seizure behaviours and EEG spiking increased, tachycardia also developed, with a maximum heart rate increase of 38 ± 7% coinciding with QTc prolongation and T wave elevation. Both clonidine and atenolol pretreatment attenuated seizure activity and reduced KA-induced changes in heart rate, QTc interval and T wave amplitude observed during both bradycardic and tachycardic phases in saline-pretreated KA animals. Clonidine, however, failed to reduce the power of EEG frequencies. Atenolol and to a lesser extent clonidine attenuated the cardiac hypercontraction band necrosis, inflammatory infiltration, and oedema at 48 h after KA, relative to the saline-KA group. CONCLUSIONS AND IMPLICATIONS Severe seizure activity in this model was clearly associated with altered ECG activity and cardiac pathology. We suggest that modulation of sympathetic activity by atenolol provides a promising cardioprotective approach in status epilepticus.
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Affiliation(s)
- M I Read
- Department of Pharmacology, University of Otago School of Medical Sciences, Dunedin, New Zealand
| | - J C Harrison
- Department of Pharmacology, University of Otago School of Medical Sciences, Dunedin, New Zealand
| | - D S Kerr
- Department of Pharmacology, University of Otago School of Medical Sciences, Dunedin, New Zealand
| | - I A Sammut
- Department of Pharmacology, University of Otago School of Medical Sciences, Dunedin, New Zealand
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154
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Wandschneider B, Koepp M, Scott C, Micallef C, Balestrini S, Sisodiya SM, Thom M, Harper RM, Sander JW, Vos SB, Duncan JS, Lhatoo S, Diehl B. Structural imaging biomarkers of sudden unexpected death in epilepsy. Brain 2015; 138:2907-19. [PMID: 26264515 PMCID: PMC4671481 DOI: 10.1093/brain/awv233] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/26/2015] [Indexed: 01/23/2023] Open
Abstract
The mechanisms underlying sudden unexpected death in epilepsy (SUDEP) remain unclear. Wandschneider et al. reveal increased amygdalo-hippocampal volume in cases of SUDEP and in individuals at high risk, compared to individuals at low risk and people without epilepsy. Findings are consistent with histopathological reports in sudden infant death syndrome. Sudden unexpected death in epilepsy is a major cause of premature death in people with epilepsy. We aimed to assess whether structural changes potentially attributable to sudden death pathogenesis were present on magnetic resonance imaging in people who subsequently died of sudden unexpected death in epilepsy. In a retrospective, voxel-based analysis of T1 volume scans, we compared grey matter volumes in 12 cases of sudden unexpected death in epilepsy (two definite, 10 probable; eight males), acquired 2 years [median, interquartile range (IQR) 2.8] before death [median (IQR) age at scanning 33.5 (22) years], with 34 people at high risk [age 30.5 (12); 19 males], 19 at low risk [age 30 (7.5); 12 males] of sudden death, and 15 healthy controls [age 37 (16); seven males]. At-risk subjects were defined based on risk factors of sudden unexpected death in epilepsy identified in a recent combined risk factor analysis. We identified increased grey matter volume in the right anterior hippocampus/amygdala and parahippocampus in sudden death cases and people at high risk, when compared to those at low risk and controls. Compared to controls, posterior thalamic grey matter volume, an area mediating oxygen regulation, was reduced in cases of sudden unexpected death in epilepsy and subjects at high risk. The extent of reduction correlated with disease duration in all subjects with epilepsy. Increased amygdalo-hippocampal grey matter volume with right-sided changes is consistent with histo-pathological findings reported in sudden infant death syndrome. We speculate that the right-sided predominance reflects asymmetric central influences on autonomic outflow, contributing to cardiac arrhythmia. Pulvinar damage may impair hypoxia regulation. The imaging findings in sudden unexpected death in epilepsy and people at high risk may be useful as a biomarker for risk-stratification in future studies.
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Affiliation(s)
- Britta Wandschneider
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Matthias Koepp
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Catherine Scott
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Caroline Micallef
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Simona Balestrini
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 3 Neuroscience Department, Polytechnic University of Marche, Ancona, Italy
| | - Sanjay M Sisodiya
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA
| | - Maria Thom
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA
| | - Ronald M Harper
- 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Josemir W Sander
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA 5 Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sjoerd B Vos
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 6 Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - John S Duncan
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Samden Lhatoo
- 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA 7 Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Beate Diehl
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA
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The Long and the Short of It: Seizures Induce Cardiac Remodeling and Arrhythmia. Epilepsy Curr 2015; 15:90-1. [PMID: 26251651 DOI: 10.5698/1535-7597-15.2.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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156
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Scorza FA, Brunoni AR. Transcranial Direct Current Stimulation Against Sudden Unexpected Death in Epilepsy: Press That Button Again, Please. Brain Stimul 2015; 8:839-40. [DOI: 10.1016/j.brs.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022] Open
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Abstract
Implantable loop recorders (ILRs) continuously monitor electrocardiographic signals and perform real-time analysis of heart rhythm for up to 36 months. ILRs are used to evaluate transitory loss of consciousness from possible arrhythmic origin, particularly unexplained syncope, and to evaluate difficult cases of epilepsy and unexplained falls, although current indications for their application in these areas are less clearly defined. This article analyzes the current indications for ILRs according the European Society of Cardiology guidelines on the management of syncope and the European Heart Rhythm Association guidelines on the use of implantable and external electrocardiogram loop recorders, and their limitations.
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Affiliation(s)
- Franco Giada
- Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, PF Calvi Hospital, Via Largo San Giorgio 3, Noale 30033, Venice, Italy.
| | - Angelo Bartoletti
- Cardiology Division and Syncope Centre, San Giovanni di Dio Hospital, Nuovo Ospedale S. Giovanni di Dio, Florence, Italy
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158
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Lamberts RJ, Blom MT, Wassenaar M, Bardai A, Leijten FS, de Haan GJ, Sander JW, Thijs RD, Tan HL. Sudden cardiac arrest in people with epilepsy in the community: Circumstances and risk factors. Neurology 2015; 85:212-8. [PMID: 26092917 DOI: 10.1212/wnl.0000000000001755] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/10/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To ascertain whether characteristics of ventricular tachycardia/fibrillation (VT/VF) differed between people with epilepsy and those without and which individuals with epilepsy were at highest risk. METHODS We ascertained 18 people with active epilepsy identified in a community-based registry of sudden cardiac arrest (SCA) with ECG-confirmed VT/VF (cases). We compared them with 470 individuals with VT/VF without epilepsy (VT/VF controls) and 54 individuals with epilepsy without VT/VF (epilepsy controls). Data on comorbidity, epilepsy severity, and medication use were collected and entered into (conditional) logistic regression models to identify determinants of VT/VF in epilepsy. RESULTS In most cases, there was an obvious (10/18) or presumed cardiovascular cause (5/18) in view of preexisting heart disease. In 2 of the 3 remaining events, near-sudden unexpected death in epilepsy (SUDEP) was established after successful resuscitation. Cases had a higher prevalence of congenital/inherited heart disease (17% vs 1%, p = 0.002), and experienced VT/VF at younger age (57 vs 64 years, p = 0.023) than VT/VF controls. VT/VF in cases occurred more frequently at/near home (89% vs 58%, p = 0.009), and was less frequently witnessed (72% vs 89%, p = 0.048) than in VT/VF controls. Cases more frequently had clinically relevant heart disease (50% vs 15%, p = 0.005) and intellectual disability (28% vs 1%, p < 0.001) than epilepsy controls. CONCLUSION Cardiovascular disease rather than epilepsy characteristics is the main determinant of VT/VF in people with epilepsy in the community. SCA and SUDEP are partially overlapping disease entities.
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Affiliation(s)
- Robert J Lamberts
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands
| | - Marieke T Blom
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands
| | - Merel Wassenaar
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands
| | - Abdennasser Bardai
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands
| | - Frans S Leijten
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands
| | - Gerrit-Jan de Haan
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands
| | - Josemir W Sander
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands
| | - Roland D Thijs
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands
| | - Hanno L Tan
- From the Stichting Epilepsie Instellingen Nederland (SEIN) (R.J.L., M.W., G.-J.d.H., J.W.S., R.D.T.), Heemstede; Academic Medical Center (M.T.B., A.B., H.L.T.), Amsterdam; University Medical Center Utrecht (M.W., F.S.L.), Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London; Epilepsy Society (J.W.S., R.D.T.), Chalfont St Peter, UK; and LUMC Leiden University Medical Center (R.D.T.), Leiden, Netherlands.
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159
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Evaluation of Cardiovascular Risk Factors in the Wistar Audiogenic Rat (WAR) Strain. PLoS One 2015; 10:e0129574. [PMID: 26029918 PMCID: PMC4450865 DOI: 10.1371/journal.pone.0129574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 05/11/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Risk factors for life-threatening cardiovascular events were evaluated in an experimental model of epilepsy, the Wistar Audiogenic Rat (WAR) strain. Methods We used long-term ECG recordings in conscious, one year old, WAR and Wistar control counterparts to evaluate spontaneous arrhythmias and heart rate variability, a tool to assess autonomic cardiac control. Ventricular function was also evaluated using the pressure-volume conductance system in anesthetized rats. Results Basal RR interval (RRi) was similar between WAR and Wistar rats (188±5 vs 199±6 ms). RRi variability strongly suggests that WAR present an autonomic imbalance with sympathetic overactivity, which is an isolated risk factor for cardiovascular events. Anesthetized WAR showed lower arterial pressure (92±3 vs 115±5 mmHg) and exhibited indices of systolic dysfunction, such as higher ventricle end-diastolic pressure (9.2±0.6 vs 5.6±1 mmHg) and volume (137±9 vs 68±9 μL) as well as lower rate of increase in ventricular pressure (5266±602 vs 7320±538 mmHg.s-1). Indices of diastolic cardiac function, such as lower rate of decrease in ventricular pressure (-5014±780 vs -7766±998 mmHg.s-1) and a higher slope of the linear relationship between end-diastolic pressure and volume (0.078±0.011 vs 0.036±0.011 mmHg.μL), were also found in WAR as compared to Wistar control rats. Moreover, Wistar rats had 3 to 6 ventricular ectopic beats, whereas WAR showed 15 to 30 ectopic beats out of the 20,000 beats analyzed in each rat. Conclusions The autonomic imbalance observed previously at younger age is also present in aged WAR and, additionally, a cardiac dysfunction was also observed in the rats. These findings make this experimental model of epilepsy a valuable tool to study risk factors for cardiovascular events in epilepsy.
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160
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Scorza FA, Cavalheiro EA, Tufik S, Scorza CA, Andersen ML. New avenues to prevent sudden unexpected death in nocturnal frontal lobe epilepsy: follow the route established by omega-3 polyunsaturated fatty acids. Sleep Med 2015; 16:1020-1. [PMID: 26008958 DOI: 10.1016/j.sleep.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/10/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Departamento de Neurologia/Neurocirurgia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Esper A Cavalheiro
- Disciplina de Neurociência, Departamento de Neurologia/Neurocirurgia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Departamento de Neurologia/Neurocirurgia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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161
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Bellon M, Panelli RJ, Rillotta F. Epilepsy-related deaths: An Australian survey of the experiences and needs of people bereaved by epilepsy. Seizure 2015; 29:162-8. [PMID: 26076861 DOI: 10.1016/j.seizure.2015.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/07/2015] [Accepted: 05/09/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study explores the experiences and needs of bereaved family and friends following an epilepsy-related death in Australia. METHOD An online survey was used to collect demographic details of the person with epilepsy, epilepsy status, time since the death, satisfaction with service providers at the time of death, follow-up support, perceptions on how well the death was explained, and gaps in support or services. RESULTS The survey was completed by 101 respondents describing 90 deceased individuals. Mean age at death was 32.1 years, with causes of death including SUDEP, epilepsy, drowning, cardiac arrest, asphyxiation, and motor vehicle accidents. Over half of the respondents indicated that they did not know, prior to the death, people could die of epilepsy. In addition, 38% indicated the death had not been adequately explained to them. Comments revealed services and supports which should be available following a death, and recommendations for existing epilepsy support services which might help to prevent future deaths. CONCLUSION Findings highlight the need to improve community understanding and support for those affected by epilepsy and to promote informed risk assessment and communication amongst patients, families and health professionals. People bereaved by epilepsy require both immediate and long-term epilepsy-specific information and support from professionals, informal communities and peer supporters.
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Affiliation(s)
- Michelle Bellon
- Disability & Community Inclusion, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia.
| | - Rosemary June Panelli
- The Department of Medicine, The Melbourne Brain Centre, The Royal Melbourne Hospital, The University of Melbourne, 4 Central, Grattan Street, Parkville, Victoria 3052, Australia; SUDEP Action, PO Box 451, Seymour, Victoria 3660, Australia.
| | - Fiona Rillotta
- Disability & Community Inclusion, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia.
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162
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Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration. Seizure 2015; 27:19-24. [PMID: 25844030 DOI: 10.1016/j.seizure.2015.02.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. METHODS Chest X-Rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression. RESULTS Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p=0.002) in GTCS with abnormal CXR (259.7 sec) versus GTCS with normal CXR (101.2 sec). Odds-ratio for CXR abnormality was 20.46 (p=0.006) with seizure duration greater than 100 sec versus less than 100 sec. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p=0.015). CONCLUSIONS Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP.
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Abstract
Over the last years, there has been an increasing interest in the potential association between type 1 diabetes (T1D) and epilepsy. Both T1D and epilepsy are common conditions in children and adolescents, and therefore, their association might represent simply a coincidence or be related to common underlying mechanisms with a potential causal relationship. Few epidemiological studies have been performed in the pediatric population, and they have reached discordant conclusions, with some studies reporting an increased prevalence of epilepsy in children and adolescents with T1D, whereas others have not confirmed this finding. Several mechanisms could explain the occurrence of epilepsy in young people with T1D, such as metabolic abnormalities (hypo/hyperglycemia) and autoantibodies, along with a genetic predisposition and the presence of brain lesions/damage. Further studies are required to better define whether there is a causal relationship between the two conditions and to understand the underlying mechanisms.
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164
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El-Rashidy OF, Shatla RH, Youssef OI, Samir E. Cardiac autonomic balance in children with epilepsy: value of antiepileptic drugs. Pediatr Neurol 2015; 52:419-23. [PMID: 25660213 DOI: 10.1016/j.pediatrneurol.2014.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Dysfunction of the autonomous nervous system causes arrhythmias and, although previous studies have investigated the effects of epilepsy on the autonomic control of the heart, there is still uncertainty about whether imbalance of sympathetic, vagal, or both systems occurs in epilepsy as well as the effect of anticonvulsants on the autonomic system. AIM To evaluate cardiac autonomic status in children with epilepsy on antiepileptic drugs. PATIENTS AND METHODS Sixty patients with epilepsy were recruited from the Outpatient Neurology Clinic at Ain Shams University and were divided into the following groups: group I, drug naive; and group II, patients with epilepsy on regular antiepileptic drugs. The second group was further subdivided into the following groups: group IIa, received monotherapy; and group IIb, received polytherapy. Forty age- and sex-matched healthy children served as controls. Included patients underwent videorecorded electroencephalograph, Holter electrocardiogram (EKG) for time and frequency domains of heart rate variability, and standard EKG recording for QTc, QTd. RESULTS Mean values of all time domain, total power, and high-frequency power were significantly lower, whereas low-frequency and low-frequency/high-frequency power, QTc. and QTd were significantly higher in group I compared with group II and in patients compared with controls. No significant difference was found between patients on different antiepileptic drug regimens regarding heart rate variability values. A significant negative correlation was found between Chalfont severity score and 50% of difference between adjacent, normal RR intervals in patient groups. CONCLUSIONS Children with epilepsy have cardiac autonomic dysfunction evident in their heart rate variability assessment. Patients on antiepileptic drugs had better autonomic balance than those not on antiepileptic drugs. Holter and EKG follow-up should be considered for early detection in those at high-risk cardiac complications.
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Affiliation(s)
| | - Rania Hamed Shatla
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Eman Samir
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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165
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Risk of cardiovascular abnormalities in relatives of SUDEP victims: How should we proceed? Epilepsy Behav 2015; 45:223-4. [PMID: 25819951 DOI: 10.1016/j.yebeh.2015.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 11/20/2022]
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166
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Scorza FA. Fish consumption in individuals with Down syndrome with seizure disorder: news for prescription. Epilepsy Behav 2015; 44:59-60. [PMID: 25625531 DOI: 10.1016/j.yebeh.2014.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
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167
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Lamberts RJ, Blom MT, Novy J, Belluzzo M, Seldenrijk A, Penninx BW, Sander JW, Tan HL, Thijs RD. Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy. J Neurol Neurosurg Psychiatry 2015; 86:309-13. [PMID: 24946773 PMCID: PMC4345521 DOI: 10.1136/jnnp-2014-307772] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIM People with epilepsy are at increased risk of sudden cardiac arrest (SCA) due to ECG-confirmed ventricular tachycardia/fibrillation, as seen in a community-based study. We aimed to determine whether ECG-risk markers of SCA are more prevalent in people with epilepsy. METHODS In a cross-sectional, retrospective study, we analysed the ECG recordings of 185 people with refractory epilepsy and 178 controls without epilepsy. Data on epilepsy characteristics, cardiac comorbidity, and drug use were collected, and general ECG variables (heart rate (HR), PQ and QRS intervals) assessed. We analysed ECGs for three markers of SCA risk: severe QTc prolongation (male >450 ms, female >470 ms), Brugada ECG pattern, and early repolarisation pattern (ERP). Multivariate regression models were used to analyse differences between groups, and to identify associated clinical and epilepsy-related characteristics. RESULTS People with epilepsy had higher HR (71 vs 62 bpm, p<0.001) and a longer PQ interval (162.8 vs 152.6 ms, p=0.001). Severe QTc prolongation and ERP were more prevalent in people with epilepsy (QTc prolongation: 5% vs 0%; p=0.002; ERP: 34% vs 13%, p<0.001), while the Brugada ECG pattern was equally frequent in both groups (2% vs 1%, p>0.999). After adjustment for covariates, epilepsy remained associated with ERP (ORadj 2.4, 95% CI 1.1 to 5.5) and severe QTc prolongation (ORadj 9.9, 95% CI 1.1 to 1317.7). CONCLUSIONS ERP and severe QTc prolongation appear to be more prevalent in people with refractory epilepsy. Future studies must determine whether this contributes to increased SCA risk in people with epilepsy.
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Affiliation(s)
- R J Lamberts
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - M T Blom
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Novy
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK
| | - M Belluzzo
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK Neurology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Trieste, Italy
| | - A Seldenrijk
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - B W Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - J W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK
| | - H L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - R D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK LUMC Leiden University Medical Center, Leiden, The Netherlands
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168
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Young C, Shankar R, Palmer J, Craig J, Hargreaves C, McLean B, Cox D, Hillier R. Does intellectual disability increase sudden unexpected death in epilepsy (SUDEP) risk? Seizure 2015; 25:112-6. [DOI: 10.1016/j.seizure.2014.10.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 11/24/2022] Open
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169
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Assenza G, Mecarelli O, Tombini M, Pulitano P, Pellegrino G, Benvenga A, Assenza F, Campana C, Di Pino G, Di Lazzaro V. Hyperventilation induces sympathetic overactivation in mesial temporal epilepsy. Epilepsy Res 2015; 110:221-7. [DOI: 10.1016/j.eplepsyres.2014.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 11/16/2022]
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170
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Tavares JGP, Vasques ER, Arida RM, Cavalheiro EA, Cabral FR, Torres LB, Menezes-Rodrigues FS, Jurkiewicz A, Caricati-Neto A, Godoy CMG, Gomes da Silva S. Epilepsy-induced electrocardiographic alterations following cardiac ischemia and reperfusion in rats. ACTA ACUST UNITED AC 2015; 48:140-5. [PMID: 25590352 PMCID: PMC4321219 DOI: 10.1590/1414-431x20144311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/06/2014] [Indexed: 11/22/2022]
Abstract
The present study evaluated electrocardiographic alterations in rats with epilepsy
submitted to an acute myocardial infarction (AMI) model induced by cardiac ischemia
and reperfusion. Rats were randomly divided into two groups: control (n=12) and
epilepsy (n=14). It was found that rats with epilepsy presented a significant
reduction in atrioventricular block incidence following the ischemia and reperfusion
procedure. In addition, significant alterations were observed in electrocardiogram
intervals during the stabilization, ischemia, and reperfusion periods of rats with
epilepsy compared to control rats. It was noted that rats with epilepsy presented a
significant increase in the QRS interval during the stabilization period in relation
to control rats (P<0.01). During the ischemia period, there was an increase in the
QRS interval (P<0.05) and a reduction in the P wave and QT intervals (P<0.05
for both) in rats with epilepsy compared to control rats. During the reperfusion
period, a significant reduction in the QT interval (P<0.01) was verified in the
epilepsy group in relation to the control group. Our results indicate that rats
submitted to an epilepsy model induced by pilocarpine presented electrical
conductivity alterations of cardiac tissue, mainly during an AMI episode.
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Affiliation(s)
- J G P Tavares
- Departamento de Farmacologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - E R Vasques
- Departamento de Gastroenterologia, LIM 37, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R M Arida
- Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - E A Cavalheiro
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - F R Cabral
- Hospital Israelita Albert Einstein, Instituto do Cérebro, São Paulo, SP, Brasil
| | - L B Torres
- Hospital Israelita Albert Einstein, Instituto do Cérebro, São Paulo, SP, Brasil
| | - F S Menezes-Rodrigues
- Departamento de Farmacologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - A Jurkiewicz
- Departamento de Farmacologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - A Caricati-Neto
- Departamento de Farmacologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - C M G Godoy
- Departamento de Ciência e Tecnologia, Universidade Federal de São Paulo, São José dos Campos, SP, Brasil
| | - S Gomes da Silva
- Hospital Israelita Albert Einstein, Instituto do Cérebro, São Paulo, SP, Brasil
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171
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Tiron C, Campuzano O, Pérez-Serra A, Mademont I, Coll M, Allegue C, Iglesias A, Partemi S, Striano P, Oliva A, Brugada R. Further evidence of the association between LQT syndrome and epilepsy in a family with KCNQ1 pathogenic variant. Seizure 2015; 25:65-7. [PMID: 25645639 DOI: 10.1016/j.seizure.2015.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 12/22/2014] [Accepted: 01/04/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Ion channels are expressed both in the heart and in the brain, being advocated as responsible for sudden unexpected death in epilepsy but few pathogenic mutations have been identified. We aim to identify a novel gen associated with channelopathies and epilepsy in a family. METHODS We assessed a family showing epilepsy concomitant with LQTS. Index case showed prolonged QT interval. His father suffers of LQT and epilepsy. We performed a direct sequencing analysis of KCNQ1, KCNH2, KCNE1, KCNE2 and SCN5A genes. RESULTS We identified a non-synonymous heterozygous missense pathogenic mutation (p.L273F) in exon 6 of the KCNQ1 gene. All clinically affected relatives carried the same mutation. CONCLUSION We report, for a first time, a KCNQ1 mutation in a family suffering of both phenotypes, suggesting that KCNQ1 genetic variations may confer susceptibility for recurrent seizure activity increasing the risk or lead to sudden death.
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Affiliation(s)
- Coloma Tiron
- Cardiology Service, Hospital Josep Trueta, Girona, Spain; Cardiology Department, Hospital of Palamós, Palamós, Spain
| | - Oscar Campuzano
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona-IDIBGI, Unversitat de Girona, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Alexandra Pérez-Serra
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona-IDIBGI, Unversitat de Girona, Girona, Spain
| | - Irene Mademont
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona-IDIBGI, Unversitat de Girona, Girona, Spain
| | - Monica Coll
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona-IDIBGI, Unversitat de Girona, Girona, Spain
| | - Catarina Allegue
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona-IDIBGI, Unversitat de Girona, Girona, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona-IDIBGI, Unversitat de Girona, Girona, Spain
| | - Sara Partemi
- Institute of Public Health Section of Legal Medicine, School of Medicine, Catholic University, Rome, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, "G. Gaslini" Institute, Genova, Italy
| | - Antonio Oliva
- Institute of Public Health Section of Legal Medicine, School of Medicine, Catholic University, Rome, Italy
| | - Ramon Brugada
- Cardiology Service, Hospital Josep Trueta, Girona, Spain; Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona-IDIBGI, Unversitat de Girona, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain.
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172
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Scorza CA, Cavalheiro EA, Calderazzo L, de Almeida ACG, Scorza FA. Chew on this: sardines are still a healthy choice against SUDEP. Epilepsy Behav 2014; 41:21-2. [PMID: 25269690 DOI: 10.1016/j.yebeh.2014.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 01/04/2023]
Affiliation(s)
- Carla A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Esper A Cavalheiro
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Lineu Calderazzo
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Antonio-Carlos G de Almeida
- Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
| | - Fulvio A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
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173
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Moore BM, Jerry Jou C, Tatalovic M, Kaufman ES, Kline DD, Kunze DL. The Kv1.1 null mouse, a model of sudden unexpected death in epilepsy (SUDEP). Epilepsia 2014; 55:1808-16. [PMID: 25377007 DOI: 10.1111/epi.12793] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Kv1.1 potassium channel null mouse (NULL) exhibits spontaneous seizure-related bradycardia, dies following seizure, and has been proposed as a model for vagus-mediated SUDEP. We characterized the cardiac events surrounding sudden unexpected death in epilepsy (SUDEP) in NULL during terminal asystole for comparison to patients with epilepsy who exhibit bradycardia and terminal or nonterminal asystole during/following seizure and explored the contribution of vagal-mediated bradycardia to SUDEP. METHODS Electrocardiography (ECG) studies of 27 freely moving telemetered NULL mice was evaluated surrounding seizure-associated death. Chronic unilateral vagal section and, in a separate set of experiments, electrical stimulation of the cervical vagi in NULL and wild-type (WT) littermates assessed the role of the vagus nerve in seizure-related death. Seizure activity indicated by intense myogenic activity on the ECG recording correlated with visual and video recording. RESULTS All NULL died following seizures, which were preceded by normal rhythm. Bradycardia followed seizure and led to slow ventricular escape rhythm (70-150 bpm) and asystole. The sequence from seizure to asystole was complete within approximately 3 min and was similar to that reported in individuals exhibiting ictal and postictal bradycardia/asystole. To address the singular role of vagus nerves in seizure-related asystole, cervical vagus nerves were stimulated in the absence of seizure. Heart rate was reduced 3 min to values similar to that following seizure but never produced asystole, suggesting activation of the vagi alone is insufficient for SUDEP. Nevertheless, unilateral chronic section of the vagus nerve increased survival time compared to nonsectioned NULL animals, supporting a role for the vagus nerve in seizure-associated death. SIGNIFICANCE The Kv1.1 null mouse is a potential model for SUDEP in patients who experience ictal and postictal bradycardia. It offers the opportunity for evaluation of the combination of factors, in addition to vagal activation, necessary to produce a terminal asystole following seizure. It is notable that long-term studies that evaluate electroencephalography (EEG) and cardiorespiratory events surrounding nonfatal seizures may provide indices predictive of terminal seizure.
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Affiliation(s)
- Brian M Moore
- Rammelkamp Center for Education and Research, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, U.S.A
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174
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Scorza FA. The contribution of Epilepsy & behavior in the dissemination of scientific knowledge on SUDEP: a story of pride. Epilepsy Behav 2014; 40:118-9. [PMID: 25307189 DOI: 10.1016/j.yebeh.2014.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/08/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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175
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Katsiki N, Mikhailidis DP, Nair DR. The effects of antiepileptic drugs on vascular risk factors: A narrative review. Seizure 2014; 23:677-84. [DOI: 10.1016/j.seizure.2014.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/21/2014] [Accepted: 05/24/2014] [Indexed: 12/13/2022] Open
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176
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Association of Serum Trace Elements and Minerals with Genetic Generalized Epilepsy and Idiopathic Intractable Epilepsy. Neurochem Res 2014; 39:2370-6. [DOI: 10.1007/s11064-014-1439-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/13/2014] [Accepted: 09/16/2014] [Indexed: 11/08/2022]
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177
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Lin X, O'Malley H, Chen C, Auerbach D, Foster M, Shekhar A, Zhang M, Coetzee W, Jalife J, Fishman GI, Isom L, Delmar M. Scn1b deletion leads to increased tetrodotoxin-sensitive sodium current, altered intracellular calcium homeostasis and arrhythmias in murine hearts. J Physiol 2014; 593:1389-407. [PMID: 25772295 DOI: 10.1113/jphysiol.2014.277699] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/07/2014] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Na(+) current (INa) results from the integrated function of a molecular aggregate (the voltage-gated Na(+) channel complex) that includes the β subunit family. Mutations or rare variants in Scn1b (encoding the β1 and β1B subunits) have been associated with various inherited arrhythmogenic syndromes, including Brugada syndrome and sudden unexpected death in patients with epilepsy. We used Scn1b null mice to understand better the relation between Scn1b expression, and cardiac electrical function. Loss of Scn1b caused, among other effects, increased amplitude of tetrodotoxin-sensitive INa, delayed after-depolarizations, triggered beats, delayed Ca(2+) transients, frequent spontaneous calcium release events and increased susceptibility to polymorphic ventricular arrhythmias. Most alterations in Ca(2+) homeostasis were prevented by 100 nM tetrodotoxin. We propose that life-threatening arrhythmias in patients with mutations in Scn1b, a gene classically defined as ancillary to the Na(+) channel α subunit, can be partly consequent to disrupted intracellular Ca(2+) homeostasis. ABSTRACT Na(+) current (INa) is determined not only by the properties of the pore-forming voltage-gated Na(+) channel (VGSC) α subunit, but also by the integrated function of a molecular aggregate (the VGSC complex) that includes the VGSC β subunit family. Mutations or rare variants in Scn1b (encoding the β1 and β1B subunits) have been associated with various inherited arrhythmogenic syndromes, including cases of Brugada syndrome and sudden unexpected death in patients with epilepsy. Here, we have used Scn1b null mouse models to understand better the relation between Scn1b expression, and cardiac electrical function. Using a combination of macropatch and scanning ion conductance microscopy we show that loss of Scn1b in juvenile null animals resulted in increased tetrodotoxin-sensitive INa but only in the cell midsection, even before full T-tubule formation; the latter occurred concurrent with increased message abundance for the neuronal Scn3a mRNA, suggesting increased abundance of tetrodotoxin-sensitive NaV 1.3 protein and yet its exclusion from the region of the intercalated disc. Ventricular myocytes from cardiac-specific adult Scn1b null animals showed increased Scn3a message, prolonged action potential repolarization, presence of delayed after-depolarizations and triggered beats, delayed Ca(2+) transients and frequent spontaneous Ca(2+) release events and at the whole heart level, increased susceptibility to polymorphic ventricular arrhythmias. Most alterations in Ca(2+) homeostasis were prevented by 100 nM tetrodotoxin. Our results suggest that life-threatening arrhythmias in patients with mutations in Scn1b, a gene classically defined as ancillary to the Na(+) channel α subunit, can be partly consequent to disrupted intracellular Ca(2+) homeostasis in ventricular myocytes.
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Affiliation(s)
- Xianming Lin
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
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178
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Genomic biomarkers of SUDEP in brain and heart. Epilepsy Behav 2014; 38:172-9. [PMID: 24139807 PMCID: PMC3989471 DOI: 10.1016/j.yebeh.2013.09.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/12/2013] [Accepted: 09/15/2013] [Indexed: 01/22/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality, but how to predict which patients are at risk and how to prevent it remain uncertain. The underlying pathomechanisms of SUDEP are still largely unknown, but the general consensus is that seizures somehow disrupt normal cardiac or respiratory physiology leading to death. However, the proportion of SUDEP cases exhibiting cardiac or respiratory dysfunction as a critical factor in the terminal cascade of events remains unresolved. Although many general risk factors for SUDEP have been identified, the development of reliable patient-specific biomarkers for SUDEP is needed to provide more accurate risk prediction and personalized patient management strategies. Studies in animal models and patient groups have revealed at least nine different brain-heart genes that may contribute to a genetic susceptibility for SUDEP, making them potentially useful as genomic biomarkers. This review summarizes data on the relationship between these neurocardiac genes and SUDEP, discussing their brain-heart expression patterns and genotype-phenotype correlations in mouse models and people with epilepsy. These neurocardiac genes represent good first candidates for evaluation as genomic biomarkers of SUDEP in future studies. The development of validated reliable genomic biomarkers for SUDEP has the potential to transform the clinical treatment of epilepsy by pinpointing patients at risk of SUDEP and allowing optimized, genotype-guided therapeutic and prevention strategies.
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179
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Partemi S, Vidal MC, Striano P, Campuzano O, Allegue C, Pezzella M, Elia M, Parisi P, Belcastro V, Casellato S, Giordano L, Mastrangelo M, Pietrafusa N, Striano S, Zara F, Bianchi A, Buti D, La Neve A, Tassinari CA, Oliva A, Brugada R. Genetic and forensic implications in epilepsy and cardiac arrhythmias: a case series. Int J Legal Med 2014; 129:495-504. [PMID: 25119684 DOI: 10.1007/s00414-014-1063-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/05/2014] [Indexed: 12/27/2022]
Abstract
Epilepsy affects approximately 3% of the world's population, and sudden death is a significant cause of death in this population. Sudden unexpected death in epilepsy (SUDEP) accounts for up to 17% of all these cases, which increases the rate of sudden death by 24-fold as compared to the general population. The underlying mechanisms are still not elucidated, but recent studies suggest the possibility that a common genetic channelopathy might contribute to both epilepsy and cardiac disease to increase the incidence of death via a lethal cardiac arrhythmia. We performed genetic testing in a large cohort of individuals with epilepsy and cardiac conduction disorders in order to identify genetic mutations that could play a role in the mechanism of sudden death. Putative pathogenic disease-causing mutations in genes encoding cardiac ion channel were detected in 24% of unrelated individuals with epilepsy. Segregation analysis through genetic screening of the available family members and functional studies are crucial tasks to understand and to prove the possible pathogenicity of the variant, but in our cohort, only two families were available. Despite further research should be performed to clarify the mechanism of coexistence of both clinical conditions, genetic analysis, applied also in post-mortem setting, could be very useful to identify genetic factors that predispose epileptic patients to sudden death, helping to prevent sudden death in patients with epilepsy.
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Affiliation(s)
- Sara Partemi
- Institute of Legal Medicine, School of Medicine, Catholic University, Rome, Italy
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180
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Scorza FA, Cavalheiro EA, Scorza CA, Nejm MB, Ryvlin P. More children with epilepsy are dying suddenly. Epilepsy Behav 2014; 37:75-6. [PMID: 25010318 DOI: 10.1016/j.yebeh.2014.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Esper A Cavalheiro
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Mariana B Nejm
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Philippe Ryvlin
- Department of Functional Neurology and Epileptology, HCL, and TIGER, CRNL, INSERM U1028, CNRS 5292, UCBL, Lyon, France; Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
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181
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Bardai A, Blom MT, van Noord C, Verhamme KM, Sturkenboom MCJM, Tan HL. Sudden cardiac death is associated both with epilepsy and with use of antiepileptic medications. Heart 2014; 101:17-22. [PMID: 25031263 DOI: 10.1136/heartjnl-2014-305664] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Epilepsy is associated with increased risk for sudden cardiac death (SCD). We aimed to establish, in a community based study, whether this association is mediated by epilepsy per se, use of antiepileptic medications (AEMs), or both. METHODS We studied SCD cases and age/sex matched controls in a case-control study in a large scale general practitioners' research database (n=478 661 patients). SCD risk for symptomatic epilepsy (seizure <2 years before SCD), stable epilepsy (no seizure <2 years before SCD), and use of AEMs (any indication) was determined. RESULTS We identified 926 SCD cases and 9832 controls. Fourteen cases had epilepsy. Epilepsy was associated with an increased SCD risk (cases 1.5%, controls 0.5%; adjusted OR 2.8, 95% CI 1.4 to 5.3). SCD risk was increased for symptomatic epilepsy (cases 0.9%, controls 0.1%; adjusted OR 5.8, 95% CI 2.1 to 15.6), but not with stable epilepsy (cases 0.6%, controls 0.4%; adjusted OR 1.6, 95% CI 0.7 to 4.1). AEM use was found in 23 cases and was associated with an increased SCD risk (cases 2.5%, controls 0.8%; adjusted OR overall 2.6, 95% CI 1.5 to 4.3) among symptomatic epilepsy cases (cases 0.9%, controls 0.1%; adjusted OR 6.4, 95% CI 2.4 to 17.4) and non-epilepsy cases (cases 1.0%, controls 0.4%; adjusted OR 2.3, 95% CI 1.01 to 5.2). Increased SCD risk was associated with sodium channel blocking AEMs (cases 1.6%, controls 0.4%; adjusted OR 2.8, 95% CI 1.1 to 7.2), but not with non-sodium channel blocking AEMs. Carbamazepine and gabapentin were associated with increased SCD risk (carbamazepine: cases 1.1%, controls 0.3%; adjusted OR 3.2, 95% CI 1.1 to 9.2; gabapentin: cases 0.3%, controls 0.1%; adjusted OR 5.7, 95% CI 1.2 to 27.9). CONCLUSIONS Epilepsy and AEM use are both associated with increased SCD risk in the general population. Poor seizure control contributes to increased SCD risk in epilepsy, while sodium channel blockade contributes to SCD susceptibility in AEM users.
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Affiliation(s)
- Abdennasser Bardai
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte van Noord
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Katia M Verhamme
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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182
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Scorza FA, Cavalheiro EA, de Almeida ACG, de Albuquerque M, Calderazzo L, Scorza CA. Clearing the air on SUDEP: vote to ban smoking among people with epilepsy. Epilepsy Behav 2014; 36:171-2. [PMID: 24937644 DOI: 10.1016/j.yebeh.2014.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/09/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
| | - Esper A Cavalheiro
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Antonio-Carlos G de Almeida
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei, São João del-Rei, Minas Gerais, Brazil
| | - Marly de Albuquerque
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Lineu Calderazzo
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
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183
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"I'm afraid I have bad news for you …." Alcohol contributes to the occurrence of sudden unexpected death in epilepsy and years lost. Epilepsy Behav 2014; 36:131-2. [PMID: 24907499 DOI: 10.1016/j.yebeh.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/05/2014] [Indexed: 11/24/2022]
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184
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Moseley BD, Britton JW. Peri-ictal QTc changes are not associated with hypoxemia. Epilepsy Res 2014; 108:982-5. [DOI: 10.1016/j.eplepsyres.2014.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 02/07/2014] [Accepted: 03/18/2014] [Indexed: 01/18/2023]
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185
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Affiliation(s)
- Dan M Roden
- From the Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN.
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186
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Scorza FA, Siqueira GM, Scorza CA, Cavalheiro EA, Rodrigues AM, de Almeida ACG. Two-hit rodent seizure model: a promising new design for research in SUDEP. Epilepsy Behav 2014; 35:26-7. [PMID: 24792096 DOI: 10.1016/j.yebeh.2014.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
| | - Gláucio M Siqueira
- Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
| | - Carla A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Esper A Cavalheiro
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Antonio M Rodrigues
- Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
| | - Antonio-Carlos G de Almeida
- Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
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Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy, with an estimated 35% lifetime risk in this patient population. There is a surprising lack of awareness among patients and physicians of this increased risk of sudden death: in a recent survey, only 33% of Canadian paediatricians who treated patients with epilepsy knew the term SUDEP. Controversy prevails over whether cardiac arrhythmia or respiratory arrest is more important as the primary cause of death. Effective preventive strategies in high-risk patients will rely on definition of the mechanisms that lead from seizures to death. Here, we summarize evidence for the mechanisms that cause cardiac, respiratory and arousal abnormalities during the ictal and postictal period. We highlight potential cellular mechanisms underlying these abnormalities, such as a defect in the serotonergic system, ictal adenosine release, and changes in autonomic output. We discuss genetic mutations that cause Dravet and long QT syndromes, both of which are linked with increased risk of sudden death. We then highlight possible preventive interventions that are likely to decrease SUDEP incidence, including respiratory monitoring in epilepsy monitoring units and overnight supervision. Finally, we discuss treatments, such as selective serotonin reuptake inhibitors, that might be personalized to a specific genetic or pathological defect.
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188
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Almeida NM, Scorza CA, Cavalheiro EA, Scorza FA. Tambaqui (Colossoma macropomum) and epilepsy: a flourishing of fish form. Epilepsy Behav 2014; 33:73-4. [PMID: 24632357 DOI: 10.1016/j.yebeh.2014.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Neiva M Almeida
- Departamento de Gestão e Tecnologia Agroindustrial, Universidade Federal da Paraíba, Paraíba, Brazil
| | - Carla A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Esper Abrão Cavalheiro
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Fulvio Alexandre Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
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189
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Scorza FA, Duncan S, Cavalheiro EA, Scorza CA, Tufik S, Andersen ML. Sleep tight, wake up bright. Should sleep deprivation be included as a potential risk factor for SUDEP? Epilepsy Behav 2014; 33:75-6. [PMID: 24632358 DOI: 10.1016/j.yebeh.2014.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
| | - Susan Duncan
- Edinburgh and South East Scotland Epilepsy Service, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, Scotland, UK
| | - Esper A Cavalheiro
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
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190
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Scorza CA, Arida RM, Cysneiros RM, Cavalheiro EA, Scorza FA. Omega-3 intake in people with epilepsy under regular hemodialysis program: here to stay. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:474-7. [PMID: 23857616 DOI: 10.1590/0004-282x20130065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/08/2013] [Indexed: 11/22/2022]
Abstract
Among the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP), higher frequency of seizures is a very consistent issue. Furthermore, it has been established that hemodialysis-associated seizure is a complication of the dialysis procedure. Thus, since a possible relation between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program should not be neglected, we propose in this paper that omega-3 fatty acids offer opportunities for prevention of sudden cardiac death or improved treatment in people with epilepsy under the regular hemodialysis program.
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Affiliation(s)
- Carla Alessandra Scorza
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/Unifesp), São Paulo SP, Brazil
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191
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Duplyakov D, Golovina G, Lyukshina N, Surkova E, Elger CE, Surges R. Syncope, seizure-induced bradycardia and asystole: two cases and review of clinical and pathophysiological features. Seizure 2014; 23:506-11. [PMID: 24680552 DOI: 10.1016/j.seizure.2014.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 03/02/2014] [Accepted: 03/05/2014] [Indexed: 12/24/2022] Open
Abstract
Episodes of transient loss of consciousness (TLOC) are commonly due to syncope or epileptic seizures. The distinction between both entities on clinical grounds and eyewitness accounts can be challenging and is often hampered by similar clinical features. We briefly summarize syncope-related symptoms and present the case of a female patient who suffered from TLOC episodes due to both reflex syncope and epileptic seizures. Seizure-induced syncope is a rare complication particularly of non-generalized temporal lobe seizures and may be suspected in people with epilepsy who report new semiological features with sudden onset of atonia, TLOC and seizure-related falls. We review epidemiological, clinical and electroencephalographic aspects of seizure-related asystole and syncope and discuss their clinical relevance. The implantation of a cardiac pacemaker appears to efficiently prevent seizure-related falls and consecutive injuries and is an important treatment option if full seizure-control cannot be achieved in these patients. We describe a second case of a patient with refractory temporal lobe epilepsy and seizure-related syncope which ceased after the implantation of a cardiac pacemaker.
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Affiliation(s)
- Dmitry Duplyakov
- Cardiology Department, Samara Regional Cardiology Dispensary, Samara, Russia; Samara State Medical University, Samara, Russia.
| | - Galina Golovina
- Cardiology Department, VAZ Medical Center, Togliatti, Russia
| | - Natalia Lyukshina
- Neurology Department, Children's Multifield Hospital No. 1, Togliatti, Russia
| | | | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Germany.
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192
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Sarmento Vasconcelos V, Macedo CR, Souza Pedrosa A, Pereira Gomes Morais E, Torloni MR. Polyunsaturated fatty acid supplementation for drug-resistant epilepsy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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193
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Powell KL, Jones NC, Kennard JT, Ng C, Urmaliya V, Lau S, Tran A, Zheng T, Ozturk E, Dezsi G, Megatia I, Delbridge LM, Pinault D, Reid CA, White PJ, O'Brien TJ. HCN channelopathy and cardiac electrophysiologic dysfunction in genetic and acquired rat epilepsy models. Epilepsia 2014; 55:609-20. [PMID: 24592881 DOI: 10.1111/epi.12563] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Evidence from animal and human studies indicates that epilepsy can affect cardiac function, although the molecular basis of this remains poorly understood. Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels generate pacemaker activity and modulate cellular excitability in the brain and heart, with altered expression and function associated with epilepsy and cardiomyopathies. Whether HCN expression is altered in the heart in association with epilepsy has not been investigated previously. We studied cardiac electrophysiologic properties and HCN channel subunit expression in rat models of genetic generalized epilepsy (Genetic Absence Epilepsy Rats from Strasbourg, GAERS) and acquired temporal lobe epilepsy (post-status epilepticus SE). We hypothesized that the development of epilepsy is associated with altered cardiac electrophysiologic function and altered cardiac HCN channel expression. METHODS Electrocardiography studies were recorded in vivo in rats and in vitro in isolated hearts. Cardiac HCN channel messenger RNA (mRNA) and protein expression were measured using quantitative PCR and Western blotting respectively. RESULTS Cardiac electrophysiology was significantly altered in adult GAERS, with slower heart rate, shorter QRS duration, longer QTc interval, and greater standard deviation of RR intervals compared to control rats. In the post-SE model, we observed similar interictal changes in several of these parameters, and we also observed consistent and striking bradycardia associated with the onset of ictal activity. Molecular analysis demonstrated significant reductions in cardiac HCN2 mRNA and protein expression in both models, providing a molecular correlate of these electrophysiologic abnormalities. SIGNIFICANCE These results demonstrate that ion channelopathies and cardiac dysfunction can develop as a secondary consequence of chronic epilepsy, which may have relevance for the pathophysiology of cardiac dysfunction in patients with epilepsy.
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Affiliation(s)
- Kim L Powell
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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Blom MT, Cohen D, Seldenrijk A, Penninx BWJH, Nijpels G, Stehouwer CDA, Dekker JM, Tan HL. Brugada syndrome ECG is highly prevalent in schizophrenia. Circ Arrhythm Electrophysiol 2014; 7:384-91. [PMID: 24591540 DOI: 10.1161/circep.113.000927] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The causes of increased risk of sudden cardiac death in schizophrenia are not resolved. We aimed to establish (1) whether ECG markers of sudden cardiac death risk, in particular Brugada-ECG pattern, are more prevalent among patients with schizophrenia, and (2) whether increased prevalence of these ECG markers in schizophrenia is explained by confounding factors, notably sodium channel-blocking medication. METHODS AND RESULTS In a cross-sectional study, we analyzed ECGs of a cohort of 275 patients with schizophrenia, along with medication use. We determined whether Brugada-ECG was present and assessed standard ECG measures (heart rate, PQ-, QRS-, and QT-intervals). We compared the findings with nonschizophrenic individuals of comparable age (the Netherlands Study of Depression and Anxiety [NESDA] cohort; N=179) and, to account for assumed increased aging rate in schizophrenia, with individuals 20 years older (Hoorn cohort; n=1168), using multivariate regression models. Brugada-ECG was significantly more prevalent in the schizophrenia cohort (11.6%) compared with NESDA controls (1.1%) or Hoorn controls (2.4%). Moreover, patients with schizophrenia had longer QT-intervals (410.9 versus 393.1 and 401.9 ms; both P<0.05), increased proportion of mild or severe QTc prolongation (13.1% and 5.8% versus 3.4% and 0.0% [NESDA], versus 5.1 and 2.8% [Hoorn]), and higher heart rates (80.8 versus 61.7 and 68.0 beats per minute; both P<0.05). The prevalence of Brugada-ECG was still increased (9.6%) when patients with schizophrenia without sodium channel-blocking medication were compared with either of the control cohorts. CONCLUSIONS Brugada-ECG has increased prevalence among patients with schizophrenia. This association is not explained by the use of sodium channel-blocking medication.
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Affiliation(s)
- Marieke T Blom
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Dan Cohen
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Adrie Seldenrijk
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Brenda W J H Penninx
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Giel Nijpels
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Coen D A Stehouwer
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Jacqueline M Dekker
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Hanno L Tan
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.).
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Scorza CA, Cavalheiro EA, Calderazzo L, Scorza FA. Labrador retrievers and SUDEP: a simple theory that may have important applications. Epilepsy Behav 2014; 32:27-8. [PMID: 24463305 DOI: 10.1016/j.yebeh.2013.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Carla A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Esper A Cavalheiro
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Lineu Calderazzo
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Fulvio A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
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Shankar R, Jalihal V, Walker M, Laugharne R, McLean B, Carlyon E, Hanna J, Brown S, Jory C, Tripp M, Pace A, Cox D, Brown S. A community study in Cornwall UK of sudden unexpected death in epilepsy (SUDEP) in a 9-year population sample. Seizure 2014; 23:382-5. [PMID: 24630808 DOI: 10.1016/j.seizure.2014.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Epilepsy-related death, particularly sudden unexpected death in epilepsy (SUDEP), is underestimated by healthcare professionals. One argument that physicians use to justify the failure to discuss SUDEP with patients and their families is that there is a lack of evidence for any protective interventions. However, there is growing evidence of potentially modifiable risk factors for SUDEP; although large-scale trials of interventions are still lacking. We determined the main risk factors associated with SUDEP in a comprehensive community sample of epilepsy deaths in Cornwall UK from 2004 to 2012. METHODS We systemically inspected 93 cases of all epilepsy and epilepsy associated deaths which occurred in Cornwall between 2004 and 2012 made available to us by the HM Cornwall coroner. These are the deaths where epilepsy was a primary or a secondary cause. RESULTS 48 cases met the criteria for SUDEP and we elicited associated relevant risk factors. Many findings from our study are comparable to what has been reported previously. New points such as most of the population had increase in either or both seizure frequency/intensity within six months of death and majority did not have an epilepsy specialist review in the last one year to demise were noted. CONCLUSION This study is the first epidemiological study in England occurring in a whole population identifying systemically all deaths and the first large scale review in UK of SUDEP deaths since 2005. Being a community based study a key issue which was highlighted was that in the SUDEPs examined many might have been potentially preventable.
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Affiliation(s)
- Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, United Kingdom; Exeter Medical School, United Kingdom.
| | - Virupakshi Jalihal
- Cornwall Partnership NHS Foundation Trust, United Kingdom; MS Ramaiah Medical College and Hospitals, India
| | | | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, United Kingdom; Exeter Medical School, United Kingdom
| | | | | | | | | | - Caryn Jory
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Mike Tripp
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | | | - David Cox
- Cornwall Partnership NHS Foundation Trust, United Kingdom
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197
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Buchanan GF. Timing, sleep, and respiration in health and disease. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2014; 119:191-219. [PMID: 23899599 DOI: 10.1016/b978-0-12-396971-2.00008-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Breathing is perhaps the physiological function that is most vital to human survival. Without breathing and adequate oxygenation of tissues, life ceases. As would be expected for such a vital function, breathing occurs automatically, without the requirement of conscious input. Breathing is subject to regulation by a variety of factors including circadian rhythms and vigilance state. Given the need for breathing to occur continuously with little tolerance for interruption, it is not surprising that breathing is subject to both circadian phase-dependent and vigilance-state-dependent regulation. Similarly, the information regarding respiratory state, including blood-gas concentrations, can affect circadian timing and sleep-wake state. The exact nature of the interactions between breathing, circadian phase, and vigilance state can vary depending upon the species studied and the methodologies employed. These interactions between breathing, circadian phase, and vigilance state may have important implications for a variety of human diseases, including sleep apnea, asthma, sudden unexpected death in epilepsy, and sudden infant death syndrome.
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Affiliation(s)
- Gordon F Buchanan
- Department of Neurology, Yale University School of Medicine, New Haven, and Veteran's Affairs Medical Center, West Haven, Connecticut, USA
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198
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Abdalla IG, Scorza CA, Fiorini AC, Cavalheiro EA, Scorza FA. Sudden unexpected death in children with epilepsy: Hearing from parents. Epilepsy Behav 2014; 31:48-9. [PMID: 24342376 DOI: 10.1016/j.yebeh.2013.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/12/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Ively G Abdalla
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Ana C Fiorini
- Departamento de Fonoaudiologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Esper A Cavalheiro
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Fulvio A Scorza
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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199
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Fawaz A, Nasreddine W, Makke Y, Atweh S, Wazne J, Arabi M, Beydoun A. Association of cardiovascular risk factors and troponin elevation after generalized tonic-clonic seizures. Seizure 2014; 23:146-50. [DOI: 10.1016/j.seizure.2013.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/05/2013] [Accepted: 11/08/2013] [Indexed: 11/28/2022] Open
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Neligan A, Sander JW. Premature mortality in epilepsy: is it preventable? Expert Rev Neurother 2014; 11:767-70. [DOI: 10.1586/ern.11.72] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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