The neuro-cardiac axis in epilepsy
Theodora A Manolis1, Antonis A Manolis2, Apostolos Vouliotis3
1Department of Psychiatry, Eginiteio University Hospital, Athens, Greece.
European Journal of Internal Medicine
|December 5, 2025
Summary
Epilepsy significantly increases the risk of cardiovascular disease (CVD) due to a complex neuro-cardiac axis. Understanding these heart-brain interactions is crucial for managing epilepsy patients and preventing cardiac complications.
Area of Science:
- Neurology
- Cardiology
- Neuroscience
Background:
- Epilepsy is a common neurological disorder frequently co-occurring with cardiovascular disease (CVD).
- A significant bidirectional relationship, termed the neuro-cardiac axis, links brain function and cardiovascular health.
- Patients with epilepsy exhibit a 2.25-fold increased risk of developing CVD.
Purpose of the Study:
- To detail the neuro-cardiac axis and its role in cardiovascular complications in epilepsy.
- To illustrate the intricate heart-lung-brain interactions in individuals with epilepsy.
- To review the impact of epilepsy on cardiovascular outcomes.
Main Methods:
- Review and synthesis of existing literature on the neuro-cardiac axis in epilepsy.
- Tabulation of epileptogenic and anti-epileptogenic medications.
- Presentation of meta-analysis results concerning cardiovascular outcomes in epilepsy patients.
Main Results:
- The neuro-cardiac axis involves CV effects of neurological disease and neurological effects of CVD.
- Pathogenesis of neurogenic CV effects includes autonomic imbalance and catecholamine release.
- Cardiovascular complications in epilepsy include hypertension, arrhythmias (e.g., atrial fibrillation, LQTS, CPVT), and sudden cardiac death (SCD).
Conclusions:
- The neuro-cardiac axis is a critical factor in the elevated CVD risk observed in epilepsy patients.
- Understanding these interactions is vital for comprehensive patient care and risk mitigation.
- Further research into heart-brain interactions can inform targeted therapeutic strategies.
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