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Rezk A, Liu W, Nijs K, Lee JW, Rajaleelan W, Nakatani R, Al Azazi E, Englesakis M, Chowdhury T. Brain and Heart Interactions Delineating Cardiac Dysfunction in Four Common Neurological Disorders: A Systematic Review and Meta-analysis. J Neurosurg Anesthesiol 2024:00008506-990000000-00125. [PMID: 39171885 DOI: 10.1097/ana.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
Neurological and cardiovascular disorders are the leading causes of morbidity and mortality worldwide. While the effects of cardiovascular disease (CD) on the nervous system are well understood, understanding of the reciprocal relationship has only recently become clearer. Based on disability-adjusted life years, this systematic review and meta-analysis present the pooled incidence and association of CD in 4 selected common, noncommunicable neurological disorders: (1) migraine, (2) Alzheimer disease and other dementias, (3) epilepsy, and (4) head injury. Sixty-five studies, including over 4 and a half million patients, were identified for inclusion in this review. Among the 4 neurological disorders, the majority of patients (89.4%) had epilepsy, 9.6% had migraine, and 0.97% had head injury. Alzheimer disease and other dementias were reported in only 0.02% of patients. The pooled effect estimates (incidence and association) of CD in the 4 neurological disorders was 10% (95% CI: 5.8%-16.9%; I2 = 99.94%). When stratified by the neurological disorder, head injury was associated with the highest incidence of CD (28%). The 4 neurological disorders were associated with a 2-fold increased odds for developing CD in comparison to patients without neurological disorders. Epilepsy was associated with the greatest increased odds of developing CD (odds ratio: 2.25; 95% CI: 1.82-2.79; P = 0.04). In studies that reported this variable, the pooled hazard ratio was 1.64 (95% CI: 1.38-1.94), with head injury having the highest hazard ratio (2.17; 95% CI: 1.30-3.61). Large prospective database studies are required to understand the long-term consequences of CD in patients with neurological disorders.
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Affiliation(s)
- Amal Rezk
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Winnie Liu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kristof Nijs
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Jun Won Lee
- University of Saskatchewan School of Medicine, Saskatoon, Canada
| | - Wesley Rajaleelan
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, Canada
| | - Rodrigo Nakatani
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emad Al Azazi
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Canada
| | - Tumul Chowdhury
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Loureiro Fialho G, Miotto R, Tatsch Cavagnollo M, Murilo Melo H, Wolf P, Walz R, Lin K. The epileptic heart: Cardiac comorbidities and complications of epilepsy. Atrial and ventricular structure and function by echocardiography in individuals with epilepsy - From clinical implications to individualized assessment. Epilepsy Behav Rep 2024; 26:100668. [PMID: 38699061 PMCID: PMC11063386 DOI: 10.1016/j.ebr.2024.100668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
Epilepsy is an increasing global neurological health issue. Recently, epidemiological and mechanistic studies have raised concern about cardiac involvement in individuals with epilepsy. This has resulted in the "epileptic heart" concept. Epidemiological data linking epilepsy to cardiovascular disease indicate an increased risk for ventricular and atrial arrhythmias, myocardial infarction, heart failure, and sudden death among individuals with epilepsy. Pathways of this interaction comprise increased prevalence of traditional cardiac risk factors, genetic abnormalities, altered brain circuitry with autonomic imbalance, and antiseizure medications with enzyme-inducing and ionic channel-blocking proprieties. Pathophysiological findings in the atria and ventricles of patients with epilepsy are discussed. Echocardiographic findings and future applications of this tool are reviewed. A risk stratification model and future studies on cardiac risk assessment in individuals with epilepsy are proposed.
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Affiliation(s)
- Guilherme Loureiro Fialho
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Ramsés Miotto
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Márcia Tatsch Cavagnollo
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Hiago Murilo Melo
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Peter Wolf
- Danish Epilepsy Centre, Dianalund, Denmark
| | - Roger Walz
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
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Salazar Serrano G, Dias de Oliveira A, Miotto R, Lin K, Loureiro Fialho G. Aborted sudden cardiac death in a young patient with epilepsy and the Gorlin Goltz syndrome. Epilepsy Behav Rep 2024; 26:100667. [PMID: 38699063 PMCID: PMC11063993 DOI: 10.1016/j.ebr.2024.100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
Epilepsy is one of the most common chronical neurological conditions affecting over 50 million people worldwide. In addition to the stigma and discrimination, individuals with epilepsy suffer from a nearly three-fold increased risk of premature death compared to the general population. Although these premature deaths occur due to multiple causes, sudden unexpected death in epilepsy (SUDEP) still challenges neurologists and clinicians dealing with individuals with epilepsy. Recently, an increased interest in cardiac outcomes related to acute seizures and chronic epilepsy resulted in the groundbreaking development of the "epileptic heart" concept, and sudden cardiac death in individuals with epilepsy, which is 4.5 times as frequent as SUDEP according to some observational data, has gained more attention. As we gather information and learn about possible comorbidities and consequences of seizures and/or chronic epilepsy, we present a clinical case of a young patient with an unusual association of epilepsy, the Gorlin Goltz syndrome, and a cardiac fibroma with Wolf-Parkinson-White (WPW), who had multiple aborted cardiac arrests. Diagnostic challenges and multiple possible causes of sudden cardiac death in this single patient report are discussed.
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Affiliation(s)
- Guilherme Salazar Serrano
- Department of Internal Medicine, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | - Ramsés Miotto
- Cardiology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil
| | - Katia Lin
- Center for Applied Neuroscience, HU, UFSC, Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil
- Post-Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), HU, UFSC, Florianópolis, SC, Brazil
| | - Guilherme Loureiro Fialho
- Cardiology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil
- Center for Applied Neuroscience, HU, UFSC, Florianópolis, SC, Brazil
- Post-Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
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Bucci T, Mbizvo GK, Rivera-Caravaca JM, Mayer J, Marson AG, Abdul-Rahim AH, Lip GYH. Epilepsy-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications in patients with Epilepsy. Curr Probl Cardiol 2023; 48:101868. [PMID: 37295636 DOI: 10.1016/j.cpcardiol.2023.101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
The risks of cardiovascular events (CVEs) in people with epilepsy (PWE) are not well understood. To establish the short- and long-term burden of CVEs in PWE. Electronic health records from a global federated health research network (TriNetX) were used to establish a cohort of PWE. Primary outcomes were: (1) the proportion of people experiencing a composite outcome of cardiac arrest, acute heart failure (HF), acute coronary syndrome (ACS), atrial fibrillation (AF), severe ventricular arrhythmia or all-cause death within 30 days of a seizure; and (2) the 5-year risk for a composite outcome of ischemic heart diseases, stroke, hospitalization, or all-cause death in the PWE experiencing early CVEs. Cox-regression analyses with propensity score matching was used to produce hazard ratios (HRs) and 95% confidence intervals (CI). In 271,172 PWE (mean age 50 ± 20 years; 52% females), the 30-day risk of CVEs following seizure was: 8.7% for the composite outcome, 0.9% for cardiac arrest, 0.8% for HF, 1.2% for ACS, 4.1% for AF, 0.7% for severe ventricular arrhythmias, and 1.6% for all-cause death. For the 15,120 PWE experiencing CVEs within 30 days of seizure, the 5-year adjusted risks for all composite outcomes measured were significantly increased (overall HR: 2.44, 95% CI 2.37-2.51), ischemic heart diseases HR 3.23 (95% CI 3.10-3.36), stroke HR 1.56 (95% CI 1.48-1.64), hospitalization HR 2.03 (95% CI 1.97-2.10), and all-cause death HR 2.75 (95% CI 2.61-2.89). The large proportions of PWE with active disease that experience CVEs and the poor long-term outcome associated suggest the existence of an "epilepsy-heart syndrome."
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of General Surgery and Surgical Specialties "Paride Stefanini," Sapienza University of Rome, Rome, Italy.
| | - Gashirai K Mbizvo
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - José Miguel Rivera-Caravaca
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Cardiology, Hospital Clínico Universitario Virgen de La Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; Faculty of Nursing, University of Murcia, Murcia, Spain
| | - Josephine Mayer
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anthony G Marson
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Azmil H Abdul-Rahim
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Medicine for Older People, Stroke Division, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Rainhill, UK
| | - Gregory Y H Lip
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Clinical Medicine, Aalborg University, Aalborg Denmark.
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Fialho GL, Pang TD, Kong WY, Tran AP, Yu CG, Rodriguez ID, Nearing BD, Waks JW, Maher TR, Clarke JR, Shepherd A, D'Avila A, Schachter SC, Verrier RL. Individuals with chronic epilepsy have elevated P-wave heterogeneity comparable to patients with atrial fibrillation. Epilepsia 2023; 64:2361-2372. [PMID: 37329175 DOI: 10.1111/epi.17686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Identification of epilepsy patients with elevated risk for atrial fibrillation (AF) is critical given the heightened morbidity and premature mortality associated with this arrhythmia. Epilepsy is a worldwide health problem affecting nearly 3.4 million people in the United States alone. The potential for increased risk for AF in patients with epilepsy is not well appreciated, despite recent evidence from a national survey of 1.4 million hospitalizations indicating that AF is the most common arrhythmia in people with epilepsy. METHODS We analyzed inter-lead heterogeneity of P-wave morphology, a marker reflecting arrhythmogenic nonuniformities of activation/conduction in atrial tissue. The study groups consisted of 96 patients with epilepsy and 44 consecutive patients with AF in sinus rhythm before clinically indicated ablation. Individuals without cardiovascular or neurological conditions (n = 77) were also assessed. We calculated P-wave heterogeneity (PWH) by second central moment analysis of simultaneous beats from leads II, III, and aVR ("atrial dedicated leads") from standard 12-lead electrocardiography (ECG) recordings from admission day to the epilepsy monitoring unit (EMU). RESULTS Female patients composed 62.5%, 59.6%, and 57.1% of the epilepsy, AF, and control subjects, respectively. The AF cohort was older (66 ± 1.1 years) than the epilepsy group (44 ± 1.8 years, p < .001). The level of PWH was greater in the epilepsy group than in the control group (67 ± 2.6 vs. 57 ± 2.5 μV, p = .046) and reached levels observed in AF patients (67 ± 2.6 vs. 68 ± 4.9 μV, p = .99). In multiple linear regression analysis, PWH levels in individuals with epilepsy were mainly correlated with the PR interval and could be related to sympathetic tone. Epilepsy remained associated with PWH after adjustments for cardiac risk factors, age, and sex. SIGNIFICANCE Patients with chronic epilepsy have increased PWH comparable to levels observed in patients with AF, while being ~20 years younger, suggesting an acceleration in structural change and/or cardiac electrical instability. These observations are consistent with emerging evidence of an "epileptic heart" condition.
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Affiliation(s)
- Guilherme L Fialho
- Federal University of Santa Catarina, Florianopolis, Brazil
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Trudy D Pang
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Wan Yee Kong
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Anthony P Tran
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Calvin G Yu
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Ivo D Rodriguez
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Bruce D Nearing
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Jonathan W Waks
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Timothy R Maher
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - John-Ross Clarke
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Alyssa Shepherd
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Andre D'Avila
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Steven C Schachter
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Richard L Verrier
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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Fialho GL, Verrier RL, D'Avila A, Melo HM, Wolf P, Walz R, Lin K. Dual assessment of abnormal cardiac electrical dispersion and diastolic dysfunction for early detection of the epileptic heart condition. J Electrocardiol 2023; 78:69-75. [PMID: 36805647 DOI: 10.1016/j.jelectrocard.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/27/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND People with epilepsy (PWE) are at increased risk for premature death due to many factors. Sudden unexpected death in epilepsy (SUDEP) is among the most important causes of death in these individuals and possibly, sudden cardiac death (SCD) in epilepsy is also as important. The possibility of concurrent derangement in electrical and mechanical cardiac function, which could be a marker of early cardiac involvement in PWE, has not been investigated in that population. METHODS Electrical dispersion indices (T-wave peak to T-wave end, TpTe; QT dispersion, QTd; QT interval corrected for heart rate, QTc) were analyzed in patients with pharmacoresistant temporal lobe epilepsy and compared to a control group. The electromechanical relationship between those indices and echocardiographic parameters were further assessed in PWE. RESULTS In 19 PWE and 21 controls, we found greater TpTe and QTd in PWE (TpTe: 91.6 ± 16.4 ms vs. 65.2 ± 12.1 ms, p < 0.0001; and QTd: 45.3 ± 13.1 ms vs. 19 ± 6.2 ms, p < 0.0001, respectively). QTc was similar between PWE and controls (419.2 ± 31.4 ms vs. 435.1 ± 31.4 ms, p = 0.12). In multivariate linear regression, TpTe, QTc, and epilepsy duration were related to left ventricular mass; QTc was associated with left atrial volume; QTc, the number of seizures per month, epilepsy duration and antiseizure medication explained 81% of E/A mitral wave Doppler ratio. CONCLUSIONS This is the first report to demonstrate concurrent electrical dispersion and diastolic dysfunction in PWE. These noninvasive biomarkers could prove useful in early detection of the "Epileptic Heart" condition.
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Affiliation(s)
- Guilherme Loureiro Fialho
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Richard L Verrier
- Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA, USA.
| | - Andre D'Avila
- Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA, USA
| | - Hiago Murilo Melo
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Peter Wolf
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark; Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Roger Walz
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
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Trigger, risk factor, and self-organizing criticality - One more piece of the puzzle to explain increased mortality in epilepsy? Epilepsy Behav 2021; 122:108123. [PMID: 34144457 DOI: 10.1016/j.yebeh.2021.108123] [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: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
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Verrier RL, Pang TD, Nearing BD, Schachter SC. Epileptic heart: A clinical syndromic approach. Epilepsia 2021; 62:1780-1789. [PMID: 34236079 DOI: 10.1111/epi.16966] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022]
Abstract
Prevention of premature death in patients with chronic epilepsy remains a major challenge. Multiple pathophysiologic factors have been implicated, with intense investigation of cardiorespiratory mechanisms. Up to four in five patients with chronic epilepsy exhibit cardiovascular comorbidities. These findings led us to propose the concept of an "epileptic heart," defined as "a heart and coronary vasculature damaged by chronic epilepsy as a result of repeated surges in catecholamines and hypoxemia leading to electrical and mechanical dysfunction." Among the most prominent changes documented in the literature are high incidence of myocardial infarction and arrhythmia, altered autonomic tone, diastolic dysfunction, hyperlipidemia, and accelerated atherosclerosis. This suite of pathologic changes prompted us to propose for the first time in this review a syndromic approach for improved clinical detection of the epileptic heart condition. In this review, we discuss the key pathophysiologic mechanisms underlying the candidate criteria along with standard and novel techniques that permit evaluation of each of these factors. Specifically, we present evidence of the utility of standard 12-lead, ambulatory, and multiday patch-based electrocardiograms, along with measures of cardiac electrical instability, including T-wave alternans, heart rate variability to detect altered autonomic tone, echocardiography to detect diastolic dysfunction, and plasma biomarkers for assessing hyperlipidemia and accelerated atherosclerosis. Ultimately, the proposed clinical syndromic approach is intended to improve monitoring and evaluation of cardiac risk in patients with chronic epilepsy to foster improved therapeutic strategies to reduce premature cardiac death.
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Affiliation(s)
- Richard L Verrier
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Trudy D Pang
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bruce D Nearing
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Steven C Schachter
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Consortia for Improving Medicine with Innovation and Technology, Boston, Massachusetts, USA
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