Epileptic Heart
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
Synonyms and keywords:
Overview
Chronic epileptic episodes and the subsequent catecholamine surges and hypoxic events may affect the heart and coronary vessels and result in the dysfunction of the heart. This condition is known as the "epileptic heart." This concept was first described by Dr. Richard L. Verrier and his colleagues in 2020.
Historical Perspective
- Absence of cardiac activity during epileptic seizure, first described by Dr. A.E. Russell, an English physician, in 1906.[1]
- The epileptic heart was first described by Drs. Verrier, Pang, Nearing, and Schachter, in 2020.[2]
Classification
- There is no established system for the classification of the epileptic heart.
Pathophysiology
- The exact mechanisms involved in the development of the epileptic heart are still being elucidated. However, the conceptual framework below provides helpful information on the development of heart disease in patients with epilepsy.[3]
| Chronic epilepsy | |||||||||||||||||||||||||||||||||||||||
| Repeated hypoxia and subsequent myocardial ischemia | Accelerated atherosclerosis | Myocardial stunning | Vacuolization of myocytes and fibrosis | Catecholamine-induced cardiotoxicity | |||||||||||||||||||||||||||||||||||
Epilepsy and Cardiac Arrhythmia
Cardiac arrhythmias have long been observed in patients with epilepsy. Three different mechanisms explain this association:[4]
- Direct (causal) pathway
- Co-existence of epilepsy and cardiac arrhythmia in the context of genetic disorders:
- Resultant association:
- Certain anti-epileptic medications with sodium channel blocking properties have been known to cause arrhythmia.
- Seizure may also cause arrhythmia.
- Ictal phase may be associated with tachycardia, asystole, bradycardia, and AV block.
- Postictal phase may be associated with asystole, AV block, atrial flutter or fibrillation, and ventricular fibrillation.
Epilepsy and Structural Heart Disease
Three mechanisms have been suggested to explain the association between epilepsy and structural heart disease:[4]
- Direct (causal) pathway in which structural heart disease may result in stroke and subsequent epilepsy.
- Common risk factors contribute to the development of both epilepsy and structural heart disease.
- Resultant pathway:
- Epilepsy may stimulate myocardial ischemia and a Takotsubo-like syndrome.
- Certain anti-epileptic medications contribute to the development of arteriosclerosis, weight gain, non-alcoholic fatty liver disease and metabolic syndrome and result in a poorer cardiovascular risk profile.[5][6]
- On microscopic histopathological analysis of patients with epilepsy a range of pathologies has been reported. These changes include fibrosis, myofibrillar degeneration, ventricular hypertrophy, focal myocardial fibrosis, perivascular and interstitial myocardial fibrosis, and mild to moderate coronary atherosclerosis.[7][8][9]
Causes
- Epileptic heart is caused by the chronic effects of epilepsy on the heart.
Differentiating Epileptic heart from other Diseases
- Epileptic heart must be differentiated from other causes of sudden death. It should also be distinguished from sudden unexpected death in epilepsy.
Epidemiology and Demographics
Risk Factors
Screening
Currently, there is no guideline statement that recommends routine cardiac evaluation of patients with epilepsy. However, a resting 12-lead EKG and/or ambulatory EKG patch recording may be useful in identifying the patients at risk of cardiac pathology and to further follow the progression of their cardiac pathology.[2]
References
- ↑ Russell, A.E. (1906). "CESSATION OF THE PULSE DURING THE ONSET OF EPILEPTIC FITS,". The Lancet. 168 (4325): 152–154. doi:10.1016/S0140-6736(01)30477-4. ISSN 0140-6736.
- ↑ 2.0 2.1 Verrier, Richard L.; Pang, Trudy D.; Nearing, Bruce D.; Schachter, Steven C. (2020). "The Epileptic Heart: Concept and clinical evidence". Epilepsy & Behavior. 105: 106946. doi:10.1016/j.yebeh.2020.106946. ISSN 1525-5050.
- ↑ Verrier, Richard L.; Schachter, Steven C. (2018). "Is heart disease in chronic epilepsy a consequence of seizures or a fellow traveler?". Epilepsy & Behavior. 86: 211–213. doi:10.1016/j.yebeh.2018.06.027. ISSN 1525-5050.
- ↑ 4.0 4.1 Shmuely, S.; van der Lende, M.; Lamberts, R.J.; Sander, J.W.; Thijs, R.D. (2017). "The heart of epilepsy: Current views and future concepts". Seizure. 44: 176–183. doi:10.1016/j.seizure.2016.10.001. ISSN 1059-1311.
- ↑ Hamed, Sherifa A. (2014). "Atherosclerosis in epilepsy: Its causes and implications". Epilepsy & Behavior. 41: 290–296. doi:10.1016/j.yebeh.2014.07.003. ISSN 1525-5050.
- ↑ Mintzer, Scott; Trinka, Eugen; Kraemer, Günter; Chervoneva, Inna; Werhahn, Konrad J. (2018). "Impact of carbamazepine, lamotrigine, and levetiracetam on vascular risk markers and lipid-lowering agents in the elderly". Epilepsia. 59 (10): 1899–1907. doi:10.1111/epi.14554. ISSN 0013-9580.
- ↑ Leestma, Jan E.; Walczak, Thaddeus; Hughes, John R.; Kalelkar, Mitra B.; Teas, Shaku S. (1989). "A prospective study on sudden unexpected death in epilepsy". Annals of Neurology. 26 (2): 195–203. doi:10.1002/ana.410260203. ISSN 0364-5134.
- ↑ Falconer, Bertil; Rajs, Jovan (1976). "Post-mortem findings of cardiac lesions in epileptics: A preliminary report". Forensic Science. 8: 63–71. doi:10.1016/0300-9432(76)90048-0. ISSN 0300-9432.
- ↑ Bardai, Abdennasser; Blom, Marieke T; van Noord, Charlotte; Verhamme, Katia M; Sturkenboom, Miriam C J M; Tan, Hanno L (2015). "Sudden cardiac death is associated both with epilepsy and with use of antiepileptic medications". Heart. 101 (1): 17–22. doi:10.1136/heartjnl-2014-305664. ISSN 1355-6037.