Kardiale Auswirkungen epileptischer Anfälle

Zusammenfassung

Eine häufige Ursache für eine sowohl kardiologische als auch epileptologische Diagnostik sind plötzliche Bewusstseinsverluste, als deren Ursache Synkopen sowie epileptische Anfälle in Frage kommen. Überschneidungen und Gemeinsamkeiten beider Fachgebiete sind dementsprechend von großer klinischer Relevanz. Epileptische Anfälle können zu kardialen Arrhythmien bis hin zur iktalen Asystolie führen und der „Sudden unexpected death in epilepsy” (SUDEP) gehört zu den wichtigen aktuellen Forschungsgebieten der Epileptologie. Kardiale Kanalopathien wie das Long-QT-Syndrom führen zur häufigen Fehldiagnose einer Epilepsie, können aber mit epileptischen Anfällen assoziiert sein und führen daher zur Vermutung einer möglichen Verbindung zwischen kardialer und zerebraler Kanalopathie. In dieser Arbeit geben wir einen Überblick über kardiale Effekte epileptischer Anfälle sowie über mögliche pathogenetische Verbindungen kardialer und epileptischer Erkrankungen.

Abstract

Sudden loss of consciousness can be caused by syncope or epileptic seizure, which therefore requires a diagnostic work-up including cardiological and neurological examinations. Thus, in clinical practice cooperation of these two medical specialties is common and of high relevance. Seizures may lead to cardiac arrhythmia or ictal asystole, and „sudden unexpected death in epilepsy” (SUDEP) is an important field of epilepsy research. Cardiac channelopathies such as long QT syndrome may be associated with seizures, suggesting a possible link between cardiac and cerebral channelopathy. We here review in detail cardiac effects due to epileptic seizures as well as possible pathogenetic correlations between cardiac and epileptic diseases.

Schlüsselwörter

Epilepsie - Iktale Asystolie - „Sudden unexpected death in epilepsy” (SUDEP) - Long-QT-Syndrom

Keywords

epilepsy - ictal asystole - sudden unexpected death in epilepsy - long QT syndrome

Literatur

• 1 Aurlien D, Leren T P, Tauboll E, Gjerstad L. New SCN5A mutation in a SUDEP victim with idiopathic epilepsy.  Seizure. 2009;  18 158-160
• 2 Betge S, Schulze-Bahr E, Fitzek C. et al . Long QT syndrome causing grand mal epilepsy: case report, pedigree, therapeutic options, and review of the literature.  Nervenarzt. 2006;  77 1210-1217
• 3 Blumhardt L D, Smith P E, Owen L. Electrocardiographic accompaniments of temporal lobe epileptic seizures.  Lancet. 1986;  1 1051-1056
• 4 Bradley T, Dixon J, Easthope R. Unexplained fainting, near drowning and unusual seizures in childhood: screening for long QT syndrome in New Zealand families.  N Z Med J. 1999;  112 299-302
• 5 Chin P S, Branch K R, Becker K J. Myocardial infarction following brief convulsive seizures.  Neurology. 2004;  63 2453-2454
• 6 Curran M E, Splawski I, Timothy K W. et al . A molecular basis for cardiac arrhythmia: HERG mutations cause long QT syndrome.  Cell. 1995;  80 795-803
• 7 Dasheiff R M, McNamara D, Dickinson L. Efficacy of second line antiepileptic drugs in the treatment of patients with medically refractive complex partial seizures.  Epilepsia. 1986;  27 124-127
• 8 Di Gennaro G, Quarato P P, Sebastiano F. et al . Ictal heart rate increase precedes EEG discharge in drug-resistant mesial temporal lobe seizures.  Clin Neurophysiol. 2004;  115 1169-1177
• 9 Earnest M P, Thomas G E, Eden R A, Hossack K F. The sudden unexplained death syndrome in epilepsy: demographic, clinical, and postmortem features.  Epilepsia. 1992;  33 310-316
• 10 Emmi A, Wenzel H J, Schwartzkroin P A. et al . Do glia have heart? Expression and functional role for ether-a-go-go currents in hippocampal astrocytes.  J Neurosci. 2000;  20 3915-3925
• 11 Janigro D, Gasparini S, D’Ambrosio R, McKhann 2nd G, DiFrancesco D. Reduction of K+ uptake in glia prevents long-term depression maintenance and causes epileptiform activity.  J Neurosci. 1997;  17 2813-2824
• 12 Johnson J N, Hofman N, Haglund C M. et al . Identification of a possible pathogenic link between congenital long QT syndrome and epilepsy.  Neurology. 2009;  72 224-231
• 13 Keilson M J, Hauser W A, Magrill J P, Goldman M. ECG abnormalities in patients with epilepsy.  Neurology. 1987;  37 1624-1626
• 14 Keilson M J, Hauser W A, Magrill J P. Electrocardiographic changes during electrographic seizures.  Arch Neurol. 1989;  46 1169-1170
• 15 Langan Y, Nashef L, Sander J W. Sudden unexpected death in epilepsy: a series of witnessed deaths.  J Neurol Neurosurg Psychiatry. 2000;  68 211-213
• 16 Lee H W, Hong S B, Tae W S, Seo D W, Kim S E. Partial seizures manifesting as apnea only in an adult.  Epilepsia. 1999;  40 1828-1831
• 17 Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia.  Ann Neurol. 1994;  36 233-237
• 18 MacCormick J M, McAlister H, Crawford J. et al . Misdiagnosis of long QT syndrome as epilepsy at first presentation.  Ann Emerg Med. 2009;  54 26-32
• 19 Marshall D W, Westmoreland B F, Sharbrough F W. Ictal tachycardia during temporal lobe seizures.  Mayo Clin Proc. 1983;  58 443-446
• 20 Mayer H, Benninger F, Urak L. et al . EKG abnormalities in children and adolescents with symptomatic temporal lobe epilepsy.  Neurology. 2004;  63 324-328
• 21 McKeon A, Vaughan C, Delanty N. Seizure versus syncope.  Lancet Neurol. 2006;  5 171-180
• 22 Moss A J, Schwartz P J, Crampton R S. et al . The long QT syndrome. Prospective longitudinal study of 328 families.  Circulation. 1991;  84 1136-1144
• 23 Nashef L, Walker F, Allen P. et al . Apnoea and bradycardia during epileptic seizures: relation to sudden death in epilepsy.  J Neurol Neurosurg Psychiatry. 1996;  60 297-300
• 24 Natelson B H, Suarez R V, Terrence C F, Turizo R. Patients with epilepsy who die suddenly have cardiac disease.  Arch Neurol. 1998;  55 857-860
• 25 Nei M, Ho R T, Abou-Khalil B W. et al . EEG and ECG in sudden unexplained death in epilepsy.  Epilepsia. 2004;  45 338-345
• 26 Nei M, Ho R T, Sperling M R. EKG abnormalities during partial seizures in refractory epilepsy.  Epilepsia. 2000;  41 542-548
• 27 Nei M. Cardiac effects of seizures.  Epilepsy Curr. 2009;  9 91-95
• 28 Racoosin J A, Feeney J, Burkhart G, Boehm G. Mortality in antiepileptic drug development programs.  Neurology. 2001;  56 514-519
• 29 Rocamora R, Kurthen M, Lickfett L, Von Oertzen J, Elger C E. Cardiac asystole in epilepsy: clinical and neurophysiologic features.  Epilepsia. 2003;  44 179-185
• 30 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 2212-2219
• 31 Schuele S U, Bermeo A C, Alexopoulos A V. et al . Video-electrographic and clinical features in patients with ictal asystole.  Neurology. 2007;  69 434-441
• 32 Schuele S U, Bermeo A C, Locatelli E, Burgess R C, Luders H O. Ictal asystole: a benign condition?.  Epilepsia. 2008;  49 168-171
• 33 Schwartz P J, Priori S G, Spazzolini C. et al . Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias.  Circulation. 2001;  103 89-95
• 34 Schwartz P J. Idiopathic long QT syndrome: progress and questions.  Am Heart J. 1985;  109 399-411
• 35 Smith P E, Howell S J, Owen L, Blumhardt L D. Profiles of instant heart rate during partial seizures.  Electroencephalogr Clin Neurophysiol. 1989;  72 207-217
• 36 Sperling M R, Harris A, Nei M, Liporace J D, O’Connor M J. Mortality after epilepsy surgery.  Epilepsia. 2005;  46 Suppl 11 49-53
• 37 Strzelczyk A, Bauer S, Knake S. et al . Ictal asystole in temporal lobe epilepsy before and after pacemaker implantation.  Epileptic Disord. 2008;  10 39-44
• 38 Terrence C F, Rao G R, Perper J A. Neurogenic pulmonary edema in unexpected, unexplained death of epileptic patients.  Ann Neurol. 1981;  9 458-464
• 39 Tigaran S, Molgaard H, McClelland R, Dam M, Jaffe A S. Evidence of cardiac ischemia during seizures in drug refractory epilepsy patients.  Neurology. 2003;  60 492-495
• 40 Tigaran S, Rasmussen V, Dam M. et al . ECG changes in epilepsy patients.  Acta Neurol Scand. 1997;  96 72-75
• 41 Tinuper P, Bisulli F, Cerullo A. et al . Ictal bradycardia in partial epileptic seizures: Autonomic investigation in three cases and literature review.  Brain. 2001;  124 2361-2371
• 42 Tomson T, Nashef L, Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions.  Lancet Neurol. 2008;  7 1021-1031
• 43 Tomson T, Walczak T, Sillanpaa M, Sander J W. Sudden unexpected death in epilepsy: a review of incidence and risk factors.  Epilepsia. 2005;  46 Suppl 11 54-61
• 44 Vincent G M, Timothy K W, Leppert M, Keating M. The spectrum of symptoms and QT intervals in carriers of the gene for the long-QT syndrome.  N Engl J Med. 1992;  327 846-852
• 45 Viskin S, Rosovski U, Sands A J. et al . Inaccurate electrocardiographic interpretation of long QT: the majority of physicians cannot recognize a long QT when they see one.  Heart Rhythm. 2005;  2 569-574
• 46 Vohra J. The Long QT Syndrome.  Heart Lung Circ. 2007;  16 Suppl 3 S5-12
• 47 Vollmar C, Feddersen B, Beckmann B M, Kaab S, Noachtar S. Seizures on hearing the alarm clock.  Lancet. 2007;  370 2172
• 48 Weil S, Arnold S, Eisensehr I, Noachtar S. Heart rate increase in otherwise subclinical seizures is different in temporal versus extratemporal seizure onset: support for temporal lobe autonomic influence.  Epileptic Disord. 2005;  7 199-204
• 49 Woodruff B K, Britton J W, Tigaran S. et al . Cardiac troponin levels following monitored epileptic seizures.  Neurology. 2003;  60 1690-1692