Фармакологические предикторы нарушения сердечного ритма и проводимости при юношеской миоклонической эпилепсии

Юношеская миоклоническая эпилепсия (ЮМЭ) является наиболее распространенной формой генетической генерализованной эпилепсии. Пациенты с ЮМЭ имеют риск жизнеугрожающих нарушений сердечного ритма и проводимости, а также синдрома внезапной смерти, обусловленных несколькими потенциальными механизмами: генетическими, клиническими, нейроанатомическими, фармакологическими, психологическими, коморбидными. В лекции рассмотрены важные элементы знаний о фармакологических предикторах цереброкардиального синдрома и синдрома внезапной смерти при эпилепсии. Показан аритмогенный потенциал противоэпилептических препаратов, наиболее часто применяющихся при ЮМЭ: вальпроевой кислоты, леветирацетама, ламотриджина, топирамата и зонисамида. Ни один из них по риску удлинения интервала QT и сердечных аритмий нельзя отнести к классу А (препараты без риска удлинения интервала QT или TdP). Пациенты с ЮМЭ нуждаются как в динамическом видеоэлектроэнцефалографическом мониторинге, так и в суточном электрокардиографическом мониторинге для снижения риска жизнеугрожающих сердечных аритмий.

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