Heart rate variability analysis indicates preictal parasympathetic overdrive preceding seizure-induced cardiac dysrhythmias leading to sudden unexpected death in a patient with epilepsy
Heart rate variability analysis indicates preictal parasympathetic overdrive preceding seizure-induced cardiac dysrhythmias leading to sudden unexpected death in a patient with epilepsy
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DOI：
10.1111/epi.12614
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发表时间：
2014-07-01
期刊：
影响因子：
5.6
通讯作者：
Beniczky, Sandor
中科院分区：
文献类型：
--
作者：
Jeppesen, Jesper;Fuglsang-Frederiksen, Anders;Beniczky, Sandor
癫痫引起的心律失常导致癫痫猝死（SUDEP）的证据一直难以捉摸。我们提出一个局灶性皮质发育不良的病人，他患有癫痫19年，正在进行术前评估。该患者没有任何心脏病病史。在长期视频脑电图（EEG）监测中，在继发性全身性强直性癫痫发作（GTCS）后，患者出现长时间的后侧全身性脑电图抑制，心脏骤停，随后出现心律失常，尽管心肺复苏，患者仍死亡。心率变异性分析显示，与1天和7个月前的测量值相比，在致命癫痫发作前的一段时间内，副交感神经活动显著增加，也高于10名无SUDEP的GTCS患者的预测值。QTc的持续时间较短（335 ~ 358 msec）。在视频脑电图监测中记录的这一不幸病例表明，自主神经失衡和癫痫引起的心律失常是导致高危患者（短QT间期）猝死的病理机制之一。
Evidence for seizure-induced cardiac dysrhythmia leading to sudden unexpected death in epilepsy (SUDEP) has been elusive. We present a patient with focal cortical dysplasia who has had epilepsy for 19 years and was undergoing presurgical evaluation. The patient did not have any cardiologic antecedents. During long-term video-electroencephalography (EEG) monitoring, following a cluster of secondarily generalized tonicclonic seizures (GTCS), the patient had prolonged postictal generalized EEG suppression, asystole, followed by arrhythmia, and the patient died despite cardiopulmonary resuscitation. Analysis of heart rate variability showed a marked increase in the parasympathetic activity during the period preceding the fatal seizures, compared with values measured 1 day and 7 months before, and also higher than the preictal values in a group of 10 patients with GTCS without SUDEP. The duration of the QTc interval was short (335-358 msec). This unfortunate case documented during video-EEG monitoring indicates that autonomic imbalance and seizure-induced cardiac dysrhythmias contribute to the pathomechanisms leading to SUDEP in patients at risk (short QT interval).