CLINICAL, NEURO-PHYSIOLOGICAL AND NEURO-VISUAL ANALYSIS OF ADULT PATIENTS WITH FOCAL EPILEPSY AND ABNORMALITIES OF CARDIAC RHYTHM AND CONDUCTION IN THE ICTAL PERIOD
https://doi.org/10.17749/2077-8333.2018.10.1.014-024
Abstract
Objective. To conduct a survey of adult patients with focal epilepsy and ictal disturbances of cardiac rhythm and conduction, considering the disease classification, anamnesis, clinical, electroencephalographic and neuroimaging data.
Materials and methods. We selected 70 patients aged 18 to 51 years old with confirmed diagnoses of focal epilepsy with epileptic seizures persisting at the time of the study on the background of antiepileptic therapy without concomitant cardiac disorders but with confirmed ictal changes in the cardiac rhythm and conduction.
Results. Among the examined patients, those with long lasting “structural focal epilepsy”, frequent epileptic attacks, temporal and frontal-temporal epileptogenic foci, taking several antiepileptic drugs, prevailed. Most of the heart rhythm and conduction abnormalities occurred in male patients with serial paroxysms, bilateral tonic-clonic seizures, or sleep seizures.
Сonclusion. The timely detection and examination of patients with high risk of ictal arrhythmias is able to prevent disturbances of cardiac rhythm and heart conduction during epileptic seizures, including those with a life-threatening potential.
About the Authors
Y. V. Rubleva
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
Postgraduate student,
1 Ostrovityanova Str., Moscow 117997
R. A. Teryan
National medical research center of preventive medicine of the Ministry of health of the Russian Federation
Russian Federation
Russian Federation
Graduate student,
Petroverigskii pereulok, 10-3, Moscow 101100
G. G. Avakyan
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
MD, PhD, Associate Professor at the Department of Neurology, Neurosurgery and Medical Genetics,
1 Ostrovityanova Str., Moscow 117997
A. A. Savenkov
Zhadkevich Clinical Hospital, Department of Health, the City of Moscow
Russian Federation
Russian Federation
MD, PhD, Head of the Inter-branch Department of Paroxysmal Conditions
Y. V. Solomatin
The District Healthcare Facility “Diagnostic clinical center No. 1 with the Department of Healthcare of Moscow”
Russian Federation
MD, PhD, Expert in Paroxysmal Diseases
Russian Federation
MD, PhD, Expert in Paroxysmal Diseases
O. M. Oleynikova
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
MD, PhD, Associate Professor at the Department of Neurology, Neurosurgery and Medical Genetics,
1 Ostrovityanova Str., Moscow 117997
A. M. Teplysheva
The District Healthcare Facility “Diagnostic clinical center No. 62 with the Department of Healthcare of Moscow”
Russian Federation
MD, PhD, Expert in Paroxysmal Diseases
Russian Federation
MD, PhD, Expert in Paroxysmal Diseases
M. B. Mironov
Medical Center for Pediatric Neurology and Pediatrics
Russian Federation
Russian Federation
PhD, Head of Laboratory at the Medical Center for Pediatric Neurology and Pediatrics,
13/32 Andropov Avenue, Moscow 101100
T. M. Krasilshchikova
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
Assistant, Chair of Neurology, Neurosurgery and Medical Fenetics, Faculty of Pediatrics,
1 Ostrovityanova Str., Moscow 117997
S. G. Burd
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
MD, PhD, Professor at the Chair of Neurology, Neurosurgery and Medical Genetics, Faculty of Pediatrics,
1 Ostrovityanova Str., Moscow 117997
References
1. Nashef L., Garner J.W., Sander D.R., Fish S.D. Shorvon Circumstances of death in sudden death in epilepsy: interviews of bereaved relatives. J. Neurol. Neurosurg. Psychiatry. 1998; 64 (3): 349-52.
2. Van der Lende M., Surges R., Sander J.W., Thijs R.D. Cardiac arrhythmias during or after epileptic seizures. J. Neurol. Neurosurg. Psychiatry. 2016; 87 (1): 69-74.
3. Langan Y., Nashef L., Sander J.W. Sudden unexpected death in epilepsy: a series of witnessed deaths. J. Neurol. Neurosurg. Psychiatry. 2000; 68 (2): 211-3.
4. Ficker D.M., So E. L., Shen W.K., Annegers J. F., O’Brien P. C., Cascino G.D., Belau P.G. Population-based study of the incidence of sudden unexplained death in epilepsy. Neurology. 1998; 51 (5): 1270-4.
5. Monté C.P.J.A., Arends J.B. A. M., Tan I.Y., Aldenkamp A.P., Limburg M., de Krom M.C. T. F.M. Sudden unexpected death in epilepsy patients: Risk factors. Seizure. 2007; 16 (1): 1-7.
6. Kloster R., Engelskjøn T. Sudden unexpected death in epilepsy (SUDEP): a clinical perspective and a search for risk factors. J. Neurol. Neurosurg. Psychiatry. 1999; 67 (4): 439-44.
7. Tomson T., Walczak T., Sillanpaa M., Sander J.W. A.S. Sudden Unexpected Death in Epilepsy: A Review of Incidence and Risk Factors. Epilepsia. 2005; 46 (s11): 54-61.
8. Walczak T.S., Leppik I. E., D’Amelio M., Rarick J., So E., Ahman P., Ruggles K., Cascino G.D., Annegers J. F., Hauser W.A. Incidence and risk factors in sudden unexpected death in epilepsy: a prospective cohort study. Neurology. 2001; 56 (4): 519-25.
9. Saetre E., Abdelnoor M., Amlie J.P., Tossebro M., Perucca E., Taubøll E., Anfinsen O.G., Isojärvi J., Gjerstad L. Cardiac function and antiepileptic drug treatment in the elderly: a comparison between lamotrigine and sustained-release carbamazepine. Epilepsia. 2009; 50 (8): 1841-9.
10. Dixon R., Job S., Oliver R., Tompson D., Wright J.G., Maltby K., Lorch U., Taubel J. Lamotrigine does not prolong QTc in a thorough QT/QTc study in healthy subjects. Br. J. Clin. Pharmacol. 2008; 66 (3): 396-404.
11. Hennessy M. J., Tighe M.G., Binnie C.D., Nashef L. Sudden withdrawal of carbamazepine increases cardiac sympathetic activity in sleep. Neurology. 2001; 57 (99): 1650-4.
12. Timmings P. L. Sudden unexpected death in epilepsy: is carbamazepine implicated? Seizure. 1998; 7 (4): 289-91.
13. Walczak T. Do antiepileptic drugs play a role in sudden unexpected death in epilepsy? Drug Saf. 2003; 26 (10): 673-683.
14. Ishizue N., Niwano S., Saito M., Fukaya H., Nakamura H., Igarashi T., Fujiishi T., Yoshizawa T., Oikawa J., Satoh A., Kishihara J., Murakami M., Niwano H., Miyaoka H., Ako J. Polytherapy with sodium channel-blocking antiepileptic drugs is associated with arrhythmogenic ST-T abnormality in patients with epilepsy. Seizure. 2016; 40: 81-7.
15. Nilsson L., Bergman U., Diwan V., Farahmand B.Y., Persson P.G., Tomson T. Antiepileptic drug therapy and its management in sudden unexpected death in epilepsy: a case-control study. Epilepsia. 2001; 42 (5): 667-73.
16. Oppenheimer S.M., Cechetto D. F. Cardiac chronotropic organization of the rat insular cortex. Brain Res. 1990; 533 (1): 66-72.
17. Oppenheimer S.M., Gelb A., Girvin J.P., Hachinski V.C. Cardiovascular effects of human insular cortex stimulation. Neurology. 1992; 42 (9): 1727-32.
18. Oppenheimer S.M., Saleh T., Cechetto D. F. Lateral hypothalamic area neurotransmission and neuromodulation of the specific cardiac effects of insular cortex stimulation. Brain Res. 1992; 581 (1): 133-42.
19. Rugg-Gunn F.J., Simister R. J., Squirrell M., Holdright D.R., Duncan J.S. Cardiac arrhythmias in focal epilepsy: a prospective long-term study. Lancet. 2004; 364 (9452): 2212-2219.
20. Zijlmans M., Flanagan D., Gotman J. Heart rate changes and ECG abnormalities during epileptic seizures: Prevalence and definition of an objective clinical sign. Epilepsia. 2002; 43 (8): 847-854.
21. Авакян Г.Н., Блинов Д.В., Лебеде- ва А.В., Бурд С. Г., Авакян Г. Г. Классифи- кация эпилепсии Международной противоэпилептической лиги: пересмотр и обновление 2017 года. Эпилепсия и пароксизмальные состояния. 2017; 9 (1): 6-25 / Avakjan G.N., Blinov D.V., Lebedeva A.V., Burd S.G., Avakjan G.G. ILAE Classification of the epilepsies: the 2017 revision and update. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions (in Russian). DOI: 10.17749/2077-8333.2017.9.1.006-025.
22. Luhdorf, L.K. Jensen, A.M. Plesner. Epilepsy in the elderly: Incidence, social function and disability. Epilepsia. 1986; 27 (3):135-41.
23. Jansen K., Lagae L. Cardiac changes in epilepsy. Seizure. 2010; 19 (8): 455-460.
24. Nei M., Sperling M.R., Mintzer S., Ho R. T. Long-term cardiac rhythm and repolarization abnormalities in refractory focal and generalized epilepsy. Epilepsia. 2012; 53 (8): 137-140.
25. Opherc С., Coromilan J., Hirsch L. J. Heart rate and EKG changes in 102 seizures: analysis of influencing factors. Epilepsy Research. 2002; 52: 117-127.
Review
For citations:
Rubleva Y.V., Teryan R.A., Avakyan G.G., Savenkov A.A., Solomatin Y.V., Oleynikova O.M., Teplysheva A.M., Mironov M.B., Krasilshchikova T.M., Burd S.G. CLINICAL, NEURO-PHYSIOLOGICAL AND NEURO-VISUAL ANALYSIS OF ADULT PATIENTS WITH FOCAL EPILEPSY AND ABNORMALITIES OF CARDIAC RHYTHM AND CONDUCTION IN THE ICTAL PERIOD. Epilepsy and paroxysmal conditions. 2018;10(1):14-24. (In Russ.) https://doi.org/10.17749/2077-8333.2018.10.1.014-024
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