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[Epilepsy and the heart]
1Hôpital Cantonal Universitaire, Genève, Suisse.
Insights
Epilepsy and heart conditions have complex, bidirectional links. While cardiac issues can mimic seizures, epileptic events can trigger dangerous heart arrhythmias and sudden death in epilepsy patients.
Area of Science:
- Cardiology
- Neurology
- Clinical Medicine
Context:
- The relationship between epilepsy and cardiac function is intricate and bidirectional.
- Cardiac arrhythmias can precipitate syncopal attacks, sometimes misdiagnosed as epilepsy.
- Conversely, epileptic seizures can induce severe cardiac arrhythmias, contributing to sudden unexpected death in epilepsy.
Purpose:
- To explore the complex interplay between epilepsy and cardiac conditions.
- To differentiate between cardiac-induced seizures and true epileptic seizures.
- To investigate the mechanisms underlying cardiac arrhythmias during epileptic seizures and their contribution to sudden death.
Summary:
- The association between epilepsy and the heart is multifaceted, involving two main pathways.
- Cardiac arrhythmias may lead to syncopal attacks, historically termed 'cardiac epilepsy,' though true epileptic seizures can occur concurrently or be complicated by syncope.
- Epileptic seizures can provoke serious cardiac arrhythmias, a factor in the elevated sudden death rate among epilepsy patients (1/1000).
Impact:
- Highlights the need for careful differential diagnosis in patients with both epilepsy and cardiac symptoms.
- Underscores the potential cardiac risks associated with epilepsy and its treatment.
- Suggests further research into the neuro-cardiac mechanisms linking seizures, antiepileptic drugs, and myocardial function to reduce sudden cardiac death in epilepsy.
Abstract:
The relations between epilepsy and heart are complex and expressed in two opposite sides. (1) Cardiac arrhythmias may provoke epileptic seizures but these seizures are, in this case, syncopal attacks. Nevertheless, in the past, these clinical features have been individualized as "cardiac epilepsy" or epilepsy in cardiacs. However, true epileptic seizures could be observed in the course of a syncopal attack and a syncope may complicate the issue of an epileptic seizure. (2) On the other hand, epileptic seizures may provoke severe cardiac arrhythmias. The incidence rate of sudden death in patients with epilepsy is estimated to be 1/1000 patients. The exact neural mechanisms in cardiac arrhythmias seizures could explain only some of the sudden unexpected deaths observed in epileptic patients. The role of antiepileptic drugs on cardiac conduction as well as the effects of seizures or status epilepticus on the myocardium are other enigmatic aspects of the relations between epilepsy and heart.