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Hamed SA, El Hadad AF, Aladawy MA. The effect of epilepsy and antiseizure medications on cardiac autonomic functions in children with epilepsy. Expert Rev Clin Pharmacol 2024; 17:393-401. [PMID: 38349326 DOI: 10.1080/17512433.2024.2318469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Autonomic manifestations have been frequently studied in adults with epilepsy. Here, we evaluated cardiac autonomic (ANS) functions in children with epilepsy in the interictal period and determined the risks for their dysfunctions. RESEARCH DESIGN AND METHODS This study included 60 patients (boys = 25; girls = 35 age: 14.53 ± 2.54 yrs) and 25 controls. Patients were well-controlled on antiseizure medications (ASMs). The battery of testing included measuring resting heart rate (HR) and blood pressure (BP), 30:15 ratio, HR variability (HRV) response to deep breathing, Valsalva ratio and BP changes in response to standing, isometric exercise and cold. RESULTS Dizziness was reported in 25%. Autonomic dysfunctions were found in 45% (n = 27). Manifestations included high frequencies of abnormal 30:15 ratio (22%), HRV responses to deep breathing (45%), Valsalava ratio (45%), and BP responses to standing (35%), isometric exercise (27%) and cold (27%), indicating parasympathetic and sympathetic hypofunctions. There were positive correlations between parasympathetic and sympathetic dysfunctions. Logistic analysis showed that the durations of epilepsy and ASMs therapy were associated with ANS dysfunctions [95% CI: 0.895-4.719, p = 0.004]. CONCLUSIONS Parasympathetic and sympathetic autonomic hypofunctions are common in children with epilepsy. This could be due to the depressant effect of sodium channel blocker ASMs on central and/or cardiac autonomic systems.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Ali Farrag El Hadad
- Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut, Egypt
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Duff H, Sheldon RS. Ankyrin-B Defects: Serendipity and Inquisitiveness are the Mothers of Invention. CIRCULATION. CARDIOVASCULAR GENETICS 2017; 10:CIRCGENETICS.117.001698. [PMID: 28196903 DOI: 10.1161/circgenetics.117.001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Henry Duff
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Robert S Sheldon
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.
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Sedmera D, Kockova R, Vostarek F, Raddatz E. Arrhythmias in the developing heart. Acta Physiol (Oxf) 2015; 213:303-20. [PMID: 25363044 DOI: 10.1111/apha.12418] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/08/2014] [Accepted: 10/23/2014] [Indexed: 01/10/2023]
Abstract
Prevalence of cardiac arrhythmias increases gradually with age; however, specific rhythm disturbances can appear even prior to birth and markedly affect foetal development. Relatively little is known about these disorders, chiefly because of their relative rarity and difficulty in diagnosis. In this review, we cover the most common forms found in human pathology, specifically congenital heart block, pre-excitation, extrasystoles and long QT syndrome. In addition, we cover pertinent literature data from prenatal animal models, providing a glimpse into pathogenesis of arrhythmias and possible strategies for treatment.
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Affiliation(s)
- D. Sedmera
- Institute of Anatomy; First Faculty of Medicine; Charles University; Prague Czech Republic
- Institute of Physiology; Academy of Sciences of the Czech Republic; Prague Czech Republic
| | - R. Kockova
- Institute of Physiology; Academy of Sciences of the Czech Republic; Prague Czech Republic
- Department of Cardiology; Institute of Clinical and Experimental Medicine; Prague Czech Republic
| | - F. Vostarek
- Institute of Physiology; Academy of Sciences of the Czech Republic; Prague Czech Republic
| | - E. Raddatz
- Department of Physiology; Faculty of Biology and Medicine; University of Lausanne; Lausanne Switzerland
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Miller-Pinsler L, Wells PG. Deficient DNA repair exacerbates ethanol-initiated DNA oxidation and embryopathies in ogg1 knockout mice: gender risk and protection by a free radical spin trapping agent. Arch Toxicol 2014; 90:415-25. [DOI: 10.1007/s00204-014-1397-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/16/2014] [Indexed: 01/16/2023]
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Aasa KL, Purssell E, Adams MA, Ozolinš TR. In UteroDimethadione Exposure Causes Postnatal Disruption in Cardiac Structure and Function in the Rat. Toxicol Sci 2014; 142:350-60. [DOI: 10.1093/toxsci/kfu190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wu S, Fisher J, Naciff J, Laufersweiler M, Lester C, Daston G, Blackburn K. Framework for Identifying Chemicals with Structural Features Associated with the Potential to Act as Developmental or Reproductive Toxicants. Chem Res Toxicol 2013; 26:1840-61. [DOI: 10.1021/tx400226u] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Shengde Wu
- Central Product Safety Department, The Procter & Gamble Company, 8700 Mason Montgomery Road, Mason, Ohio 45040, United States
| | - Joan Fisher
- Central Product Safety Department, The Procter & Gamble Company, 8700 Mason Montgomery Road, Mason, Ohio 45040, United States
| | - Jorge Naciff
- Central Product Safety Department, The Procter & Gamble Company, 8700 Mason Montgomery Road, Mason, Ohio 45040, United States
| | - Michael Laufersweiler
- Central Product Safety Department, The Procter & Gamble Company, 8700 Mason Montgomery Road, Mason, Ohio 45040, United States
| | - Cathy Lester
- Central Product Safety Department, The Procter & Gamble Company, 8700 Mason Montgomery Road, Mason, Ohio 45040, United States
| | - George Daston
- Central Product Safety Department, The Procter & Gamble Company, 8700 Mason Montgomery Road, Mason, Ohio 45040, United States
| | - Karen Blackburn
- Central Product Safety Department, The Procter & Gamble Company, 8700 Mason Montgomery Road, Mason, Ohio 45040, United States
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DeGiorgio AC, Desso TE, Lee L, DeGiorgio CM. Ventricular tachycardia associated with lacosamide co-medication in drug-resistant epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2012; 1:26-8. [PMID: 25688050 PMCID: PMC4150657 DOI: 10.1016/j.ebcr.2012.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 11/03/2022]
Abstract
We report a case of sustained ventricular tachycardia following the initiation of lacosamide as adjunctive epilepsy treatment. A 49-year-old male with intractable frontal lobe seizures experienced severe ventricular tachycardia following the addition of 400 mg lacosamide to his existing regimen of carbamazepine, lamotrigine, clonazepam, and valproate. The tachycardia occurred during a cardiac stress test; stress tests prior to initiation of lacosamide were normal. Conduction defects, including QRS prolongation, persisted during hospitalization until lacosamide was discontinued. The patient had no prior history of cardiac arrhythmia but did possess cardiac risk factors, including hypertension, hypercholesterolemia, and low heart rate variability. This case represents one part of a growing body of literature suggesting a link between arrhythmia and use of lacosamide, which enhances slow inactivation of sodium channels in both the brain and the heart. We believe further study may be necessary to assess the safety of lacosamide in epilepsy patients with cardiac risk factors.
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Affiliation(s)
| | - Tamara E Desso
- Department of Neurology, University of California, Los Angeles, USA
| | - Lance Lee
- Department of Neurology, University of California, Los Angeles, USA ; Glendale Adventist Medical Center, USA
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Riebeling C, Hayess K, Peters AK, Steemans M, Spielmann H, Luch A, Seiler AEM. Assaying embryotoxicity in the test tube: current limitations of the embryonic stem cell test (EST) challenging its applicability domain. Crit Rev Toxicol 2012; 42:443-64. [PMID: 22512667 DOI: 10.3109/10408444.2012.674483] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Testing for embryotoxicity in vitro is an attractive alternative to animal experimentation. The embryonic stem cell test (EST) is such a method, and it has been formally validated by the European Centre for the Validation of Alternative Methods. A number of recent studies have underscored the potential of this method. However, the EST performed well below the 78% accuracy expected from the validation study using a new set of chemicals and pharmaceutical compounds, and also of toxicity criteria, tested to enlarge the database of the validated EST as part of the Work Package III of the ReProTect Project funded within the 6th Framework Programme of the European Union. To assess the performance and applicability domain of the EST we present a detailed review of the substances and their effects in the EST being nitrofen, ochratoxin A, D-penicillamine, methylazoxymethanol, lovastatin, papaverine, warfarin, β-aminopropionitrile, dinoseb, furosemide, doxylamine, pravastatin, and metoclopramide. By delineation of the molecular mechanisms of the substances we identify six categories of reasons for misclassifications. Some of these limitations might also affect other in vitro methods assessing embryotoxicity. Substances that fall into these categories need to be included in future validation sets and in validation guidelines for embryotoxicity testing. Most importantly, we suggest conceivable improvements and additions to the EST which will resolve most of the limitations.
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Affiliation(s)
- Christian Riebeling
- German Federal Institute for Risk Assessment (BfR), ZEBET - Alternative Methods to Animal Experiments, Berlin, Germany
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Wells PG, McCallum GP, Chen CS, Henderson JT, Lee CJJ, Perstin J, Preston TJ, Wiley MJ, Wong AW. Oxidative stress in developmental origins of disease: teratogenesis, neurodevelopmental deficits, and cancer. Toxicol Sci 2009; 108:4-18. [PMID: 19126598 DOI: 10.1093/toxsci/kfn263] [Citation(s) in RCA: 288] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In the developing embryo and fetus, endogenous or xenobiotic-enhanced formation of reactive oxygen species (ROS) like hydroxyl radicals may adversely alter development by oxidatively damaging cellular lipids, proteins and DNA, and/or by altering signal transduction. The postnatal consequences may include an array of birth defects (teratogenesis), postnatal functional deficits, and diseases. In animal models, the adverse developmental consequences of in utero exposure to agents like thalidomide, methamphetamine, phenytoin, benzo[a]pyrene, and ionizing radiation can be modulated by altering pathways that control the embryonic ROS balance, including enzymes that bioactivate endogenous substrates and xenobiotics to free radical intermediates, antioxidative enzymes that detoxify ROS, and enzymes that repair oxidative DNA damage. ROS-mediated signaling via Ras, nuclear factor kappa B and related transducers also may contribute to altered development. Embryopathies can be reduced by free radical spin trapping agents and antioxidants, and enhanced by glutathione depletion. Further modulatory approaches to evaluate such mechanisms in vivo and/or in embryo culture have included the use of knockout mice, transgenic knock-ins and mutant deficient mice with altered enzyme activities, as well as antisense oligonucleotides, protein therapy with antioxidative enzymes, dietary depletion of essential cofactors and chemical enzyme inhibitors. In a few cases, measures anticipated to be protective have conversely enhanced the risk of adverse developmental outcomes, indicating the complexity of development and need for caution in testing therapeutic strategies in humans. A better understanding of the developmental effects of ROS may provide insights for risk assessment and the reduction of adverse postnatal consequences.
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Affiliation(s)
- Peter G Wells
- Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
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Teng GQ, Zhao X, Lees-Miller JP, Quinn FR, Li P, Rancourt DE, London B, Cross JC, Duff HJ. Homozygous missense N629D hERG (KCNH2) potassium channel mutation causes developmental defects in the right ventricle and its outflow tract and embryonic lethality. Circ Res 2008; 103:1483-91. [PMID: 18948620 DOI: 10.1161/circresaha.108.177055] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Loss-of-function mutations in the human ERG1 potassium channel (hERG1) frequently underlie the long QT2 (LQT2) syndrome. The role of the ERG potassium channel in cardiac development was elaborated in an in vivo model of a homozygous, loss-of-function LQT2 syndrome mutation. The hERG N629D mutation was introduced into the orthologous mouse gene, mERG, by homologous recombination in mouse embryonic stem cells. Intact homozygous embryos showed abrupt cessation of the heart beat. N629D/N629D embryos die in utero by embryonic day 11.5. Their developmental defects include altered looping architecture, poorly developed bulbus cordis, and distorted aortic sac and branchial arches. N629D/N629D myocytes from embryonic day 9.5 embryos manifested complete loss of I(Kr) function, depolarized resting potential, prolonged action potential duration (LQT), failure to repolarize, and propensity to oscillatory arrhythmias. N629D/N629D myocytes manifest calcium oscillations and increased sarcoplasmic reticulum Ca(+2) content. Although the N629D/N629D protein is synthesized, it is mainly located intracellularly, whereas +/+ mERG protein is mainly in plasmalemma. N629D/N629D embryos show robust apoptosis in craniofacial regions, particularly in the first branchial arch and, to a lesser extent, in the cardiac outflow tract. Because deletion of Hand2 produces apoptosis, in similar regions and with a similar final developmental phenotype, Hand2 expression was evaluated. Robust decrease in Hand2 expression was observed in the secondary heart field in N629D/N629D embryos. In conclusion, loss of I(Kr) function in N629D/N629D cardiovascular system leads to defects in cardiac ontogeny in the first branchial arch, outflow tract, and the right ventricle.
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Affiliation(s)
- Guo Qi Teng
- Libin Cardiovascular Institute, University of Calgary, Canada
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