Pathologic cardiac repolarization in pharmacoresistant epilepsy and its potential role in sudden unexpected death in epilepsy: A case-control study
Pathologic cardiac repolarization in pharmacoresistant epilepsy and its potential role in sudden unexpected death in epilepsy: A case-control study
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DOI：
10.1111/j.1528-1167.2009.02330.x
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发表时间：
2010-02-01
期刊：
影响因子：
5.6
通讯作者：
Walker, Matthew C.
中科院分区：
文献类型：
--
作者：
Surges, Rainer;Adjei, Patrick;Walker, Matthew C.
目的：确定癫痫患者是否发生心脏复极异常和其他心电图（ECG）预测心脏死亡率，以及它们是否与癫痫猝死（SUDEP）风险增加相关。在配对病例对照研究中，记录了死于SUDEP的耐药性局灶性癫痫成年患者，这些患者既往接受过术前视频EEG检查（脑电图）遥测。生活对照组的年龄，性别和入院日期相匹配的视频脑电图遥测。评估了围发作期心率（HR）、校正QT间期（QTc）、发作后HR恢复、HR变异性和心律。结果：38例患者（每组19例）共记录到91次癫痫发作。89例癫痫发作中有9例和38例患者中有5例QTc延长超过病理上限。34例患者中有9例显示病理性QT离散度。病理性心脏复极和其他心电图特征均与SUDEP无特异性相关。SUDEP患者，但是，更有可能缺乏病理性脑磁共振成像（MRI）的结果，不太可能经历抗癫痫药物减少遥测，并有更多的继发全身强直阵挛性发作（SGTCS）每年。病理性心脏复极在耐药性局灶性癫痫的成人患者中并不少见，可能有利于致命性快速性心律失常的发生，这是SUDEP的一个合理原因。SGTCS是SUDEP的危险因素，与复杂部分性癫痫发作相比，对心脏活动的不利影响更大，因此可能会额外损害心脏功能。
Purpose: To determine whether abnormal cardiac repolarization and other electrocardiography (ECG) predictors for cardiac mortality occur in epilepsy patients and whether they are associated with an increased risk for sudden unexpected death in epilepsy (SUDEP).Methods: In a matched-pair case-control study, recordings of adult patients with pharmacoresistant focal epilepsies who died from SUDEP and who had previously had presurgical video-EEG (electroencephalography) telemetry were reviewed. Living controls were matched for age, gender, and date of admission for video-EEG telemetry. Periictal heart rate (HR), corrected QT interval (QTc), postictal HR recovery, HR variability, and cardiac rhythm were assessed. QT dispersion was analyzed with 12-lead ECG.Results: A total of 38 patients (19 per group) had 91 recorded seizures. QTc was prolonged above pathologic upper limits in 9 of 89 seizures and 5 of 38 patients. Nine of 34 patients displayed patho-logic QT dispersion. Presence of neither pathologic cardiac repolarization nor other ECG features were specifically associated with SUDEP. SUDEP patients were, however, more likely to lack pathologic cerebral magnetic resonance imaging (MRI) findings, less likely to experience antiepileptic drug reduction during telemetry, and had more secondarily generalized tonic-clonic seizures (SGTCS) per year.Discussion: Our study did not reveal a clear-cut ECG predictor for SUDEP. Pathologic cardiac repolarization is not uncommon in adult patients with pharmacoresistant focal epilepsy and could favor occurrence of fatal tachyarrhythmia as one plausible cause for SUDEP. SGTCS are a risk factor for SUDEP, have, as compared to complex-partial seizures, a greater, unfavorable impact on heart activity, and may thereby additionally compromise cardiac function.