Seizure
journal homepage: www.elsevier.com/locate/yseiz
Review
A R T I C L E I N F O
A B S T R A C T
Article history:
Received 5 January 2010
Received in revised form 5 July 2010
Accepted 9 July 2010
Epilepsy and seizures can have a dramatic effect on the autonomic nervous system by involvement of the
central autonomic control centers. The peri-ictal changes can lead to short-term alteration of cardiac
functions in patients with seizures, and are partially hemispheric specic. Changes in heart rhythm,
conduction and even subtle signs of ischemia have been reported. Ictal asystole and the lock-step
phenomenon during seizures play an important role in the pathophysiology of SUDEP. In patients with
longlasting epilepsy and multiple seizures, there are now convincing arguments for a chronic
dysfunction of the autonomic nervous system. In this sense, heart rate variability can be considered as a
biomarker of autonomic dysfunction in epilepsy. Early recognition of these short- and long-term cardiac
effects will become useful in predicting seizures and in guiding more individualized treatment in the
near future.
2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Keywords:
Autonomic
Heart
Childhood epilepsy
SUDEP
Nervus vagus
Contents
1.
2.
3.
4.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acute cardiac changes and epilepsy . . . . . . . . . .
2.1.
Tachycardia . . . . . . . . . . . . . . . . . . . . . . . .
2.2.
Bradycardia and asystole . . . . . . . . . . . . .
2.3.
Conduction disorders . . . . . . . . . . . . . . . .
2.4.
SUDEP . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.5.
Syncope . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.6.
Cardiac ischemia . . . . . . . . . . . . . . . . . . . .
Chronic cardiac changes in epilepsy . . . . . . . . . .
3.1.
Heart rate variability (HRV) . . . . . . . . . . .
3.2.
AED and HRV . . . . . . . . . . . . . . . . . . . . . .
3.3.
Chronic and refractory epilepsy and HRV
3.4.
Vagal nerve stimulation (VNS) and HRV .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1. Introduction
It has been shown that epilepsy and seizures can have a
profound effect on cardiac function. Subtle cardiac rhythm changes
in the preictal and ictal period are potential biomarkers and can be
used in algorithms to anticipate and detect seizures. The
phenomenon of SUDEP is closely linked to ictal cardiac changes.
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1059-1311/$ see front matter 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.seizure.2010.07.008
456
457
death in epilepsy patients (SUDEP). Tachycardia leading to malignant ventricular tachycardia and ventricular brillation has been
illustrated to be the cause of near SUDEP in a patient with TLE.20
458
459
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