Details

Autor(en) / Beteiligte

• Verrier, Richard L.
• Pang, Trudy D.
• Nearing, Bruce D.
• Schachter, Steven C.

Titel

The Epileptic Heart: Concept and clinical evidence

Ist Teil von

• Epilepsy & behavior, 2020-04, Vol.105, p.106946-106946, Article 106946

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• Sudden unexpected death in epilepsy (SUDEP) is generally considered to result from a seizure, typically convulsive and usually but not always occurring during sleep, followed by a sequence of events in the postictal period starting with respiratory distress and progressing to eventual cardiac asystole and death. Yet, recent community-based studies indicate a 3-fold greater incidence of sudden cardiac death in patients with chronic epilepsy than in the general population, and that in 66% of cases, the cardiac arrest occurred during routine daily activity and without a temporal relationship with a typical seizure. To distinguish a primarily cardiac cause of death in patients with epilepsy from the above description of SUDEP, we propose the concept of the “Epileptic Heart” 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.” This review starts with an overview of the pathophysiological and other lines of evidence supporting the biological plausibility of the Epileptic Heart, followed by a description of tools that have been used to generate new electrocardiogram (EKG)-derived data in patients with epilepsy that strongly support the Epileptic Heart concept and its propensity to cause sudden cardiac death in patients with epilepsy independent of an immediately preceding seizure. •Chronic epilepsy damages the structural integrity of the heart and its vasculature, “The Epileptic Heart.”•Epilepsy confers a 3-fold higher risk for sudden cardiac death than in the general population beyond SUDEP.•T-wave alternans can detect arrhythmia risk to improve diagnosis and guide therapy.•Vagus nerve stimulation can afford dual protection by reducing seizure and suppressing cardiac electrical instability.