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Zhao H, Long L, Xiao B. Advances in sudden unexpected death in epilepsy. Acta Neurol Scand 2022; 146:716-722. [DOI: 10.1111/ane.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Haiting Zhao
- Department of Neurology Xiangya Hospital, Central South University Changsha China
- National Clinical Research Center for Geriatric Disorders Xiangya Hospital, Central South University Changsha China
- Clinical Research Center for Epileptic Disease of Hunan Province Central South University Changsha China
| | - Lili Long
- Department of Neurology Xiangya Hospital, Central South University Changsha China
- National Clinical Research Center for Geriatric Disorders Xiangya Hospital, Central South University Changsha China
- Clinical Research Center for Epileptic Disease of Hunan Province Central South University Changsha China
| | - Bo Xiao
- Department of Neurology Xiangya Hospital, Central South University Changsha China
- National Clinical Research Center for Geriatric Disorders Xiangya Hospital, Central South University Changsha China
- Clinical Research Center for Epileptic Disease of Hunan Province Central South University Changsha China
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Trivisano M, Muccioli L, Ferretti A, Lee HF, Chi CS, Bisulli F. Risk of SUDEP during infancy. Epilepsy Behav 2022; 131:107896. [PMID: 33741238 DOI: 10.1016/j.yebeh.2021.107896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 11/03/2022]
Abstract
Risk of sudden unexpected death in epilepsy (SUDEP) in children is influenced by different factors such as etiology, seizure type and frequency, treatment, and environment. A greater severity of epilepsy, in terms of seizure frequency, seizures type, especially with nocturnal generalized tonic-clonic seizures (GTCS), and resistance to anti-seizure medication are predisposing factors to SUDEP. Potential mechanisms of SUDEP might involve respiratory, cardiovascular, and central autonomic dysfunctions, either combined or in isolation. Patients with epilepsy carrying mutations in cardiac channelopathy genes might be disposed to seizure-induced arrhythmias. Other than in channelopathies, SUDEP has been reported in further patients with genetic epilepsies due to mutations of genes such as DEPDC5, TBC1D24, FHF1, or 5q14.3 deletion. Age-related electro-clinical differences in GTCS may therefore be relevant in explaining differences in SUDEP between adults and children. Typical GTCS represent a rare seizure type in infants and toddlers, they are characterized by a shorter tonic phase and, in direct proportion, by shorter postictal generalized EEG suppression (PGES). The presence of night-time supervision has been found to reduce SUDEP risk, likely reducing SUDEP incidence in children. Reconsideration of safety protocols in epilepsy monitoring units with the aim of reducing the risk of SUDEP, and the use of devices for seizure detection, might contribute to reduce the risk of death in patients affected by epilepsy. This article is part of the Special Issue "Severe Infantile Epilepsies".
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Affiliation(s)
- Marina Trivisano
- Rare and Epilepsies Unit, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy.
| | - Lorenzo Muccioli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Alessandro Ferretti
- Rare and Epilepsies Unit, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
| | - Hsiu-Fen Lee
- Division of Pediatric Neurology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Shiang Chi
- Division of Pediatric Neurology, Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Francesca Bisulli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Scorza FA, de Almeida ACG, Scorza CA, Finsterer J. Sudden unexpected death in epilepsy and abnormal glucose metabolism in the rat insular cortex: A brain within the heart. Clinics (Sao Paulo) 2022; 77:100059. [PMID: 35905578 PMCID: PMC9335350 DOI: 10.1016/j.clinsp.2022.100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
| | - Antonio-Carlos G de Almeida
- Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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Negishi Y, Aoki Y, Itomi K, Yasuda K, Taniguchi H, Ishida A, Arakawa T, Miyamoto S, Nakashima M, Saitsu H, Saitoh S. SCN8A-related developmental and epileptic encephalopathy with ictal asystole requiring cardiac pacemaker implantation. Brain Dev 2021; 43:804-808. [PMID: 33827760 DOI: 10.1016/j.braindev.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION SCN8A-related epilepsy has various phenotypes. In particular, patients with developmental and epileptic encephalopathy (DEE) are resistant to antiepileptic drugs and may present with autonomic symptoms, such as marked bradycardia and apnea during seizures, and thus have an increased risk of sudden death. Herein, we report a case of very severe SCN8A-related epilepsy necessitating cardiac pacemaker implantation because of repetitive ictal asystole. CASE REPORT The patient was a 14-month-old girl. Tremor and generalized tonic seizure occurred after birth. During seizures, bradycardia and perioral cyanosis occurred, and then, after developing tachycardia and apnea, marked bradycardia and generalized cyanosis occurred, which sometimes resulted in ictal asystole requiring cardiopulmonary resuscitation. Her seizures were refractory to antiepileptic drugs. As the seizures requiring resuscitation did not decrease, cardiac pacemaker implantation was performed four months after birth. Exome sequencing revealed a heterozygous de novo variant in SCN8A (NM_014191.3:c.4934T>C,p.(Met1645Thr)). Even though phenytoin was effective, seizures with bradycardia remained approximately once a month, and pacemaker activity was observed. CONCLUSIONS This is, to our knowledge, the first reported case of SCN8A-related DEE in whom pacemaker implantation was performed. Pacemaker implantation should be considered as a treatment option for critical patients with SCN8A-related DEE as in the present case, because the incidence of sudden unexpected death in epilepsy is reported to be approximately 10% in patients with SCN8A-related DEE.
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Affiliation(s)
- Yutaka Negishi
- Department of Pediatrics, Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Yusuke Aoki
- Department of Neurology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Kazuya Itomi
- Department of Neurology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Kazushi Yasuda
- Department of Cardiology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Hiroaki Taniguchi
- Department of Pediatrics, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Atsushi Ishida
- Department of Pediatrics, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Takeshi Arakawa
- Department of Pediatrics, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Sachiko Miyamoto
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mitsuko Nakashima
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotomo Saitsu
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Akyüz E, Üner AK, Köklü B, Arulsamy A, Shaikh MF. Cardiorespiratory findings in epilepsy: A recent review on outcomes and pathophysiology. J Neurosci Res 2021; 99:2059-2073. [PMID: 34109651 DOI: 10.1002/jnr.24861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
Epilepsy is a debilitating disorder of uncontrollable recurrent seizures that occurs as a result of imbalances in the brain excitatory and inhibitory neuronal signals, that could stem from a range of functional and structural neuronal impairments. Globally, nearly 70 million people are negatively impacted by epilepsy and its comorbidities. One such comorbidity is the effect epilepsy has on the autonomic nervous system (ANS), which plays a role in the control of blood circulation, respiration and gastrointestinal function. These epilepsy-induced impairments in the circulatory and respiratory systems may contribute toward sudden unexpected death in epilepsy (SUDEP). Although, various hypotheses have been proposed regarding the role of epilepsy on ANS, the linking pathological mechanism still remains unclear. Channelopathies and seizure-induced damages in ANS-control brain structures were some of the causal/pathological candidates of cardiorespiratory comorbidities in epilepsy patients, especially in those who were drug resistant. However, emerging preclinical research suggest that neurotransmitter/receptor dysfunction and synaptic changes in the ANS may also contribute to the epilepsy-related autonomic disorders. Thus, pathological mechanisms of cardiorespiratory dysfunction should be elucidated by considering the modifications in anatomy and physiology of the autonomic system caused by seizures. In this regard, we present a comprehensive review of the current literature, both clinical and preclinical animal studies, on the cardiorespiratory findings in epilepsy and elucidate the possible pathological mechanisms of these findings, in hopes to prevent SUDEP especially in patients who are drug resistant.
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Affiliation(s)
- Enes Akyüz
- Department of Biophysics, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Arda Kaan Üner
- Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Betül Köklü
- Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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Khalil M, Shukralla AA, Kilbride R, Mullins G, Widdess-Walsh P, Delanty N, El-Naggar H. Ictal asystole during long-term video-EEG; semiology, localization, and intervention. Epilepsy Behav Rep 2021; 15:100416. [PMID: 33437961 PMCID: PMC7786025 DOI: 10.1016/j.ebr.2020.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/23/2022] Open
Abstract
Ictal arrhythmias are disturbances of cardiac conduction that occur during clinical or electrographic seizures. Ictal asystole (IA) is rare, and its incidence can range from 0.3–0.4% in patients with epilepsy who were monitored by video-EEG (van der Lende et al., 2015). We report on ten patients (six males and four females) with an age ranging from 31 to 70 years old) who were monitored in our video-EEG (VEEG) unit over the last eight years. These patients were selected based on the history of documented ictal asystole during inpatient VEEG monitoring). In our series the mean latency from the seizure onset to the onset of ictal asystole was 22 seconds and the mean duration of the IA was 15.8 seconds. During the asystolic phase the seizures may clinically continue or syncopal signs may supervene. In our case series all the patients had either left or right temporal lobe epilepsy, six of which were lesional. We found two patterns of ictal semiology in our series. The first group of patients included five patients who experienced a rapid onset of IA in their seizure and the second group where the latency of ictal asystole was relatively late. All our cohort had a permanent pacemaker following the diagnosis, six of these patients have been event free since placement.
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Raghu ALB, Parker T, van Wyk A, Green AL. Insula stroke: the weird and the worrisome. Postgrad Med J 2019; 95:497-504. [PMID: 31296791 DOI: 10.1136/postgradmedj-2019-136732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/10/2019] [Accepted: 06/23/2019] [Indexed: 01/10/2023]
Abstract
Infarction of the insula is a common scenario with large tissue-volume strokes in the middle cerebral artery territory. Considered to be part of the central autonomic network, infarction of this region is associated with autonomic disturbances, in particular cardiovascular dysregulation. Risk of aspiration following stroke is also associated with involvement of the insula, consistent with its purported participation in complex functions of the mouth and pharynx. Strokes restricted to the insula are rare and present with a broad range of symptoms that offer a window of insight into the diverse functionality of the insular cortex. Chemosensory, autonomic, vestibular, auditory, somatosensory, language and oropharyngeal functional deficits are all recognised, among others. Long-term sequelae are unknown but profound symptoms, such as hemiparesis, are usually transient. Understanding the patterns of dysfunction highlighted provides the basis for future strategies to optimise stroke management on the discovery of insula involvement.
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Affiliation(s)
| | - Tariq Parker
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - André van Wyk
- Acute Stroke Unit, Royal Berkshire Hospital, Reading, UK
| | - Alexander Laurence Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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The effect of unilateral stroke on autonomic function in the term newborn. Pediatr Res 2019; 85:830-834. [PMID: 30712058 DOI: 10.1038/s41390-019-0320-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 12/28/2018] [Accepted: 01/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The mature cerebral cortex has a topographically organized influence on reflex autonomic centers of the brainstem and diencephalon and sympathetic activation coming primarily from the right hemisphere and parasympathetic activation from the left. In the term newborn, the maturational status of this central autonomic system remains poorly understood. METHODS Sixteen term newborns admitted to Children's National with unilateral middle cerebral artery (MCA) strokes (n = 8 left, n = 8 right) had archived continuous electrocardiograph (EKG) signals available. We compared stroke laterality and severity with indices of autonomic function, as measured by heart rate variability. We performed both time- and frequency-domain analyses on the R-R interval (RRi) over 24h of continuous EKG data at around 7 days of age. RESULTS Right MCA stroke significantly increased sympathetic tone, while left MCA stroke increased parasympathetic tone. Regardless of laterality, stroke severity was associated inversely with sympathetic tone and positively with parasympathetic tone. Surprisingly, injury to either insular region had no significant autonomic effect. Phenobarbital blood levels were positively associated with sympathetic tone and inversely related to parasympathetic tone. CONCLUSION Based on these findings, it is difficult to reconcile the functional topography of the central autonomic system in term newborns with that currently proposed for the normal mature brain. Further investigation is clearly needed.
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Thom M, Boldrini M, Bundock E, Sheppard MN, Devinsky O. Review: The past, present and future challenges in epilepsy-related and sudden deaths and biobanking. Neuropathol Appl Neurobiol 2019; 44:32-55. [PMID: 29178443 PMCID: PMC5820128 DOI: 10.1111/nan.12453] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/14/2017] [Indexed: 12/14/2022]
Abstract
Awareness and research on epilepsy-related deaths (ERD), in particular Sudden Unexpected Death in Epilepsy (SUDEP), have exponentially increased over the last two decades. Most publications have focused on guidelines that inform clinicians dealing with these deaths, educating patients, potential risk factors and mechanisms. There is a relative paucity of information available for pathologists who conduct these autopsies regarding appropriate post mortem practice and investigations. As we move from recognizing SUDEP as the most common form of ERD toward in-depth investigations into its causes and prevention, health professionals involved with these autopsies and post mortem procedure must remain fully informed. Systematizing a more comprehensive and consistent practice of examining these cases will facilitate (i) more precise determination of cause of death, (ii) identification of SUDEP for improved epidemiological surveillance (the first step for an intervention study), and (iii) biobanking and cell-based research. This article reviews how pathologists and healthcare professionals have approached ERD, current practices, logistical problems and areas to improve and harmonize. The main neuropathology, cardiac and genetic findings in SUDEP are outlined, providing a framework for best practices, integration of clinical, pathological and molecular genetic investigations in SUDEP, and ultimately prevention.
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Affiliation(s)
- M Thom
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - M Boldrini
- Department of Psychiatry, Columbia University Medical Centre, Divisions of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - E Bundock
- Office of the Chief Medical Examiner, Burlington, VT, USA
| | - M N Sheppard
- Department of Pathology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - O Devinsky
- Department of Neurology, NYU Epilepsy Center, New York, NY, USA
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Manolis TA, Manolis AA, Melita H, Manolis AS. Sudden unexpected death in epilepsy: The neuro-cardio-respiratory connection. Seizure 2019; 64:65-73. [DOI: 10.1016/j.seizure.2018.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/09/2018] [Accepted: 12/13/2018] [Indexed: 12/21/2022] Open
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Zhang X, Sun L, Cui L, Lin W. Sudden unexpected death in epilepsy in a 14-year-old girl: case report and literature review. J Int Med Res 2018; 46:2031-2036. [PMID: 29557234 PMCID: PMC5991225 DOI: 10.1177/0300060518762265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with epilepsy. The pathogenesis of SUDEP is still unclear. The majority of SUDEP cases occur in intractable epilepsy, especially in the aftermath of a generalized tonic-clonic seizure. We report an atypical SUDEP case with infrequent seizures in frontal lobe epilepsy. Case Report A 14-year-old girl presented with a 13-year history of paroxysmal convulsions. She experienced three episodes within 6–10 months after birth. At 14 years old, she experienced an aggravated seizure, manifesting as unconsciousness, hyperventilation, and urinary incontinence. Electroencephalography showed spike-slow waves and slow waves with mixed asynchronized spike waves originating from the frontal lobe during the sleep stage. Transient outbreaks of spike-slow complex waves (1–2 s) were also noted in all leads. The diagnosis of frontal lobe epilepsy (generalized tonic-clonic seizures secondary to focal impaired awareness seizures and myoclonus) was made. Oral sodium valproate was prescribed. However, she suddenly died on her way to school 2 months later. Conclusion The causes of SUDEP are complicated, and frontal lobe epilepsy may be a potential risk factor. Early diagnosis and appropriate treatment of epileptic seizures, as well as close observation, should be emphasized.
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Affiliation(s)
- Xinyue Zhang
- 1 Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lichao Sun
- 2 Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Li Cui
- 1 Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Weihong Lin
- 1 Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Desai R, Rupareliya C, Patel U, Naqvi S, Patel S, Lunagariya A, Mahuwala Z. Burden of Arrhythmias in Epilepsy Patients: A Nationwide Inpatient Analysis of 1.4 Million Hospitalizations in the United States. Cureus 2017; 9:e1550. [PMID: 29018647 PMCID: PMC5630461 DOI: 10.7759/cureus.1550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Arrhythmias have been one of the common complications in epilepsy patients and have also been the reason for death. However, limited data exist about the burden and outcomes of arrhythmias by subtypes in epilepsy. Our study aims at evaluating the burden and differences in outcomes of various subtypes of arrhythmias in epilepsy patient population. The Nationwide Inpatient Sample (NIS) database from 2014 was examined for epilepsy and arrhythmias related discharges using appropriate International Classification of Disease, Ninth Revision Clinical Modification (ICD-9-CM) codes. The frequency of arrhythmias, gender differences in arrhythmia by subtypes, in-hospital outcomes and mortality predictors was analyzed. A total of 1,424,320 weighted epilepsy patients was determined and included in this study. Around 23.9% (n =277,230) patients had cardiac arrhythmias. The most frequent arrhythmias in the descending frequency were: atrial fibrillation (AFib) 9.7%, other unspecified causes 7.3%, sudden cardiac arrest (SCA) 1.4%, bundle branch block (BBB) 1.2%, ventricular tachycardia (VT) 1%. Males were more predisposed to cardiac arrhythmias compared to females (OR [odds ratio]: 1.1, p <0.001). The prevalence of most subtypes arrhythmias was higher in males. Arrhythmias were present in nearly a quarter of patients with epilepsy. Life threatening arrhythmias were more common in male patients. The length of stay (LOS) and mortality were significantly higher in epilepsy patients with arrhythmia. It is imperative to develop early diagnosis and prompt therapeutic measures to reduce this burden and poor outcomes due to concomitant arrhythmias in epilepsy patients.
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Affiliation(s)
- Rupak Desai
- Research Coordinator, Atlanta Veterans Affairs Medical Center
| | | | | | - Syeda Naqvi
- Jinnah Postgraduate Medical Centre, Jinnah Sindh Medical University (SMC)
| | - Smit Patel
- Department of Neurology, University of Connecticut Health Center
| | | | - Zabeen Mahuwala
- Department of Neurology, University Of Kentucky College of Medicine
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