Cardiac adverse effects of antiseizure medications
Gaetano Zaccara1, Simona Lattanzi2, Francesco Brigo3
1Department of Eidemiology, Regional Health Agency of Tuscany, Firenze, Italy.
Insights
Patients with epilepsy face increased cardiovascular risks. While antiseizure medications (ASMs) can help, some ASMs also pose cardiac risks, necessitating careful consideration and monitoring.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Patients with epilepsy, particularly severe forms, exhibit heightened susceptibility to cardiovascular diseases and arrhythmias.
- Seizures can lead to cardiac structural alterations and electrical instability.
- Antiseizure medications (ASMs) present a dual role: indirect cardiovascular protection via seizure reduction and direct cardiotoxic effects.
Purpose of the Study:
- To review the cardiovascular implications of antiseizure medications (ASMs) in epilepsy patients.
- To highlight both the protective and detrimental cardiac effects of ASMs.
- To emphasize the importance of considering cardiotoxicity in ASM selection and patient management.
Main Methods:
- Literature review and analysis of existing studies on ASMs and cardiovascular health in epilepsy.
- Examination of the mechanisms underlying both beneficial and adverse cardiac effects of ASMs.
- Evaluation of specific ASM properties, including effects on ion channels and potential for atherogenesis.
Main Results:
- Some ASMs possess cardioprotective properties, including anti-inflammatory, antioxidant, hypotensive, and lipid-reducing effects.
- ASMs can induce long-term cardiotoxicity, increasing risks of atherogenesis and cardiovascular disease.
- Immediate cardiac risks include potentially fatal arrhythmias due to ion channel influence, particularly with sodium channel blockers.
- Specific drugs like fenfluramine may cause valvulopathies, warranting further investigation in epilepsy populations.
Conclusions:
- Cardiotoxic effects of ASMs must be a key consideration when selecting treatments for epilepsy.
- Regular cardiac monitoring is recommended for epilepsy patients undergoing ASM treatment.
- Personalized treatment strategies considering individual cardiac risk factors are essential.
Introduction:
Patients with severe epilepsy are at increased risk of cardiovascular disease and arrhythmias. Although antiseizure medications (ASMs) may have indirect protective effects against cardiovascular events by reducing seizure frequency and hence sudden death in epilepsy, some of them exert cardiotoxic effects.
Areas Covered:
Patients with epilepsy, mainly those with severe forms, are at higher risk of cardiac disease because their heart can have structural alterations and electrical instability as a consequence of repeated seizures. Some ASMs have direct protective effects through anti-inflammatory, antioxidant, hypotensive, and lipid-reducing properties. Antiseizure medications can also have toxic cardiac effects including both long-term consequences, such as the increased risk of atherogenesis and subsequent cardiovascular disease due to the influence on lipid profile and pro-inflammatory milieu, and immediate effects as the increased risk of potentially fatal arrhythmias due to the influence on ion channels. Sodium channel blocking ASMs may also affect cardiac sodium channels and this effect is particularly observed in subjects with genetic mutations in cardiac ion channels. Fenfluramine cause valvulopathies in obese subjects and this effect need to be evaluated in epilepsy patients.
Expert Opinion:
For the selection of treatment, cardiotoxic effects of ASMs should be considered; cardiac monitoring of treatment is advisable.
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