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Cardiovascular manifestations of autonomic epilepsy

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Abstract

Cardiovascular autonomic manifestations of seizures occur frequently in the epileptic population. Common manifestations include alterations in heart rate and rhythm, blood pressure, ECG changes and chest pain. The neuroanatomical and neurophysiological underpinnings of these autonomic manifestations are not been fully elucidated. Diagnostic confusion may arise when ictal symptoms are confined to the autonomic nervous system; conversely, such symptoms in association with convulsions or altered consciousness are more readily recognized as concomitant ictal features. Awareness of the diverse autonomic manifestations of epilepsy will enhance diagnosis and lead to more effective therapy of these patients.

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References

  1. Neurogenic pulmonary oedema, Editorial (1985) Lancet 1:1430–431

    Google Scholar 

  2. Ahern GL, Howard GF, Weiss KL (1988) Posttraumatic pilomotor seizures: a case report. Epilepsia 29:640–43

    Article  CAS  PubMed  Google Scholar 

  3. Annegers JF, Coan SP (1999) SUDEP: overview of definitions and review of incidence data. Seizure 8:347–52

    Article  CAS  PubMed  Google Scholar 

  4. Ballardie FW, Murphy RP, Davis J (1983) Epilepsy: a presentation of the Romano-Ward syndrome. BMJ—Clin Res 287:896–97

    CAS  Google Scholar 

  5. Baumgartner C, Lurger S, Leutmezer F (2001) Autonomic symptoms during epileptic seizures. Epileptic Disord 3:103–16

    CAS  PubMed  Google Scholar 

  6. Benarroch EE (1993) The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc 68:988–001

    CAS  PubMed  Google Scholar 

  7. Benassi E, Bo GP, Cocito L, Maffini M, Loeb C (1987) Carbamazepine and cardiac conduction disturbances. Ann Neurol 22:280–81

    Article  CAS  PubMed  Google Scholar 

  8. Blumhardt LD, Smith PE, Owen L (1986) Electrocardiographic accompaniments of temporal lobe epileptic seizures. Lancet 1:1051–056

    Article  CAS  PubMed  Google Scholar 

  9. Boesen F, Andersen EB, Jensen EK, Ladefoged SD (1983) Cardiac conduction disturbances during carbamazepine therapy. Acta Neurol Scand 68:49–2

    CAS  PubMed  Google Scholar 

  10. Bricker JT, Garson A Jr, Gillette PC (1984) A family history of seizures associated with sudden cardiac deaths. Am J Dis Children 138:866–68

    CAS  Google Scholar 

  11. Brody IA, Odom GL, Kunkle EC (1960) Pilomotor seizures: report of a case associated with a central glioma. Neurology 10:993–97

    Google Scholar 

  12. Brown RW, McLeod WR (1973) Sympathetic stimulation with temporal lobe epilepsy. Med J Aust 2:274–76

    CAS  PubMed  Google Scholar 

  13. Cechetto DF (1987) Central representation of visceral function. Fed Proc 46:17–3

    CAS  PubMed  Google Scholar 

  14. Cechetto DF, Saper CB (1990) Role of the cerebral cortex in autonomic function. In: Loewy AD, Spyer KM (eds) Central regulation of autonomic functions. Oxford University Press, New York

  15. Cerullo A, Tinuper P, Provini F, Contin M, Rosati A, Marini C, Cortelli P (1998) Autonomic and hormonal ictal changes in gelastic seizures from hypothalamic hamartomas. Electroencephalogr Clin Neurophysiol 107:317–22

    Article  CAS  PubMed  Google Scholar 

  16. Constantin L, Martins JB, Fincham RW, Dagli RD (1990) Bradycardia and syncope as manifestations of partial epilepsy. J Am Coll Cardiol 15:900–05

    CAS  PubMed  Google Scholar 

  17. Dasheiff RM (1991) Sudden unexpected death in epilepsy: a series from an epilepsy surgery program and speculation on the relationship to sudden cardiac death. J Clin Neurophysiol 8:216–22

    CAS  PubMed  Google Scholar 

  18. Devinsky O, Price BH, Cohen SI (1986) Cardiac manifestations of complex partial seizures. Am J Med 80:195–02

    Article  CAS  PubMed  Google Scholar 

  19. Di Gennaro G, Quarato PP, Sebastiano F, Esposito V, Onorati P, Grammaldo LG, Meldolesi GN, Mascia A, Falco C, Scoppetta C, Eusebi F, Manfredi M, Cantore G (2004) Ictal heart rate increase precedes EEG discharge in drug-resistant mesial temporal lobe seizures. Clin Neurophysiol 115:1169–177

    Article  PubMed  Google Scholar 

  20. Earnest MP, Thomas GE, Eden RA, Hossack KF (1992) The sudden unexplained death syndrome in epilepsy: demographic, clinical, and postmortem features. Epilepsia 33:310–16

    Article  CAS  PubMed  Google Scholar 

  21. Epstein MA, Sperling MR, O’Connor MJ (1992) Cardiac rhythm during temporal lobe seizures. Neurology 42:50–3

    CAS  PubMed  Google Scholar 

  22. Ficker DM (2000) Sudden unexplained death and injury in epilepsy. Epilepsia 41(Suppl 2):S7–S12

    Article  PubMed  Google Scholar 

  23. Ficker DM, So EL, Shen WK, Annegers JF, O’Brien PC, Cascino GD, Belau PG (1998) Population-based study of the incidence of sudden unexplained death in epilepsy. Neurology 51:1270–274

    CAS  PubMed  Google Scholar 

  24. Fincham RW, Shivapour ET, Leis AA, Martins JB (1992) Ictal bradycardia with syncope: a case report (see comments). Neurology 42:2222–223

    CAS  PubMed  Google Scholar 

  25. Freeman R, Schachter SC (1995) Autonomic epilepsy. Semin Neurol 15:158–66

    Article  CAS  PubMed  Google Scholar 

  26. Garcia M, D’Giano C, Estelles S, Leiguarda R, Rabinowicz A (2001) Ictal tachycardia: its discriminating potential between temporal and extratemporal seizure foci. Seizure 10:415–19

    CAS  PubMed  Google Scholar 

  27. Gospe SM Jr, Choy M (1989) Hereditary long Q-T syndrome presenting as epilepsy: electroencephalography laboratory diagnosis. Ann Neurol 25:514–16

    Article  PubMed  Google Scholar 

  28. Green JB (1984) Pilomotor seizures. Neurology 34:837–39

    CAS  PubMed  Google Scholar 

  29. Hennessy MJ, Tighe MG, Binnie CD, Nashef L (2001) Sudden withdrawal of carbamazepine increases cardiac sympathetic activity in sleep. Neurology 57:1650–654

    CAS  PubMed  Google Scholar 

  30. Hilz MJ, Devinsky O, Doyle W, Mauerer A, Dutsch M (2002) Decrease of sympathetic cardiovascular modulation after temporal lobe epilepsy surgery. Brain 125:985–95

    Article  CAS  PubMed  Google Scholar 

  31. Hirsh CS, Martin DL (1971) Unexpected death in young epileptics. Neurology 21:682–90

    Google Scholar 

  32. Jacome DE, Seroppian ER (1988) Ictal bradycardia. Am J Med Sci 295:469–71

    Article  CAS  PubMed  Google Scholar 

  33. Janjigian ER (1953) Cardiac epilepsy simulating the anginal syndrome. Am J Med 110:34–0

    CAS  Google Scholar 

  34. Jervell A, Lange-Nielsen F (1957) Congenital deaf mutism, functional heart disease with prolongation of the QT interval and sudden death. Am Heart J 54:59–8

    Article  CAS  PubMed  Google Scholar 

  35. Johnston SC, Horn JK, Valente J, Simon RP (1995) The role of hypoventilation in a sheep model of epileptic sudden death. Ann Neurol 37:531–37

    Article  CAS  PubMed  Google Scholar 

  36. Johnston SC, Siedenberg R, Min JK, Jerome EH, Laxer KD (1997) Central apnea and acute cardiac ischemia in a sheep model of epileptic sudden death. Ann Neurol 42:588–94

    Article  CAS  PubMed  Google Scholar 

  37. Keilson MJ, Hauser WA, Magrill JP (1989) Electrocardiographic changes during electrographic seizures. Arch Neurol 46:1169–170

    CAS  PubMed  Google Scholar 

  38. Keilson MJ, Hauser WA, Magrill JP, Goldman M (1987) ECG abnormalities in patients with epilepsy. Neurology 37:1624–626

    CAS  PubMed  Google Scholar 

  39. Kenneback G, Bergfeldt L, Vallin H, Tomson T, Edhag O (1991) Electrophysiologic effects and clinical hazards of carbamazepine treatment for neurologic disorders in patients with abnormalities of the cardiac conduction system. Am Heart J 121:1421–429

    Article  CAS  PubMed  Google Scholar 

  40. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ (1987) Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 59:256–62

    Article  CAS  PubMed  Google Scholar 

  41. Ladefoged SD, Mogelrang JC (1982) Total atrioventricular block with syncopes complicating carbamazepine therapy. Acta Med Scand 212:185–86

    CAS  PubMed  Google Scholar 

  42. Lagerkranser M, Pehrsson K, Sylven C (1982) Neurogenic pulmonary edema: a review of the pathophysiology with clinical and therapeutic implications. Acta Med Scand 212:267–71

    CAS  PubMed  Google Scholar 

  43. Lathers CM, Schraeder PL (1982) Autonomic dysfunction in epilepsy: characterization of autonomic cardiac neural discharge associated with pentylenetetrazol-induced epileptogenic activity. Epilepsia 23:633–47

    Article  CAS  PubMed  Google Scholar 

  44. Leestma JE, Kalelkar MB, Teas SS, Jay GW, Hughes JR (1984) Sudden unexpected death associated with seizures: analysis of 66 cases. Epilepsia 25:84–8

    Article  CAS  PubMed  Google Scholar 

  45. Leestma JE, Walczak T, Hughes JR, Kalelkar MB, Teas SS (1989) A prospective study on sudden unexpected death in epilepsy. Ann Neurol 26:195–03

    Article  CAS  PubMed  Google Scholar 

  46. Leutmezer F, Schernthaner C, Lurger S, Potzelberger K, Baumgartner C (2003) Electrocardiographic changes at the onset of epileptic seizures. Epilepsia 44:348–54

    Article  PubMed  Google Scholar 

  47. Lown B, DeSilva RA, Lenson R (1976) Neural activity and ventricular fibrillation. N Engl J Med 294:1165–170

    Article  CAS  PubMed  Google Scholar 

  48. Marshall DW, Westmoreland BF, Sharbrough FW (1983) Ictal tachycardia during temporal lobe seizures. Mayo Clin Proc 58:443–46

    CAS  PubMed  Google Scholar 

  49. Mathew NT, Taoti GM, Mathai KV, Chandy J (1970) Atrial fibrillation associated with seizure in a case of frontal meningioma. Neurology 20:725–28

    CAS  PubMed  Google Scholar 

  50. Metz SA, Halter JB, Porte D Jr, Robertson RP (1978) Autonomic epilepsy: clonidine blockade of paroxysmal catecholamine release and flushing. Ann Intern Med 88:189–93

    CAS  PubMed  Google Scholar 

  51. Mulder D, Daly D, Bailey A (1954) Visceral epilepsy. Arch Intern Med 93:481–93

    CAS  Google Scholar 

  52. Myers GA, Martin GJ, Magid NM, Barnett PS, Schaad JW, Weiss JS, Lesch M, Singer DH (1986) Power spectral analysis of heart rate variability in sudden cardiac death: comparison to other methods. IEEE Trans Biomed Eng 33:1149–156

    Article  CAS  PubMed  Google Scholar 

  53. Natelson BH, Suarez RV, Terrence CF, Turizo R (1998) Patients with epilepsy who die suddenly have cardiac disease. Arch Neurol 55:857–60

    Article  CAS  PubMed  Google Scholar 

  54. Nathan MA, Reis DJ (1975) Fulminating arterial hypertension with pulmonary edema from release of adrenomedullary catecholamines after lesions of the anterior hypothalamus in the rat. Circ Res 7:226–35

    Google Scholar 

  55. Nei M, Ho RT, Sperling MR (2000) EKG abnormalities during partial seizures in refractory epilepsy. Epilepsia 41:542–48

    Article  CAS  PubMed  Google Scholar 

  56. Opeskin K, Thomas A, Berkovic SF (2000) Does cardiac conduction pathology contribute to sudden unexpected death in epilepsy? Epilepsy Res 40:17–4

    Article  CAS  PubMed  Google Scholar 

  57. Opherk C, Coromilas J, Hirsch LJ (2002) Heart rate and EKG changes in 102 seizures: analysis of influencing factors. Epilepsy Res 52:117–27

    Article  PubMed  Google Scholar 

  58. Pacia SV, Devinsky O, Luciano DJ, Vazquez B (1994) The prolonged QT syndrome presenting as epilepsy: a report of two cases and literature review. Neurology 44:1408–410

    CAS  PubMed  Google Scholar 

  59. Pedley TA, Hauser WA (2002) Sudden death in epilepsy: a wake-up call for management. Lancet 359:1790–791

    Article  PubMed  Google Scholar 

  60. Phizackerley PJR, Poole EW, Whitty CWM (1954) Sinoauricular heart block as an epileptic manifestation. Epilepsia 3:89–1

    Article  CAS  PubMed  Google Scholar 

  61. Pignata C, Farina V,Andria G, Del Giudice E, Striano S, Adinolfi L (1983) Prolonged Q-T interval syndrome presenting as idiopathic epilepsy. Neuropediatrics 14:235–36

    Article  CAS  PubMed  Google Scholar 

  62. Reeves AL, Nollet KE, Klass DW, Sharbrough FW, So EL (1996) The ictal bradycardia syndrome. Epilepsia 37:983–87

    Article  CAS  PubMed  Google Scholar 

  63. Reynolds RW (1963) Pulmonary edema as a consequence of hypothalamic lesions in rats. Science 141:930–32

    Article  CAS  PubMed  Google Scholar 

  64. Rocamora R, Kurthen M, Lickfett L, Von Oertzen J, Elger CE (2003) Cardiac asystole in epilepsy: clinical and neurophysiologic features. Epilepsia 44:179–85

    Article  CAS  PubMed  Google Scholar 

  65. Romano C, Lemme G, Pongiglione R (1963) Aritmie cardiache rare dell’eta’pediatrica. Clin Paediatr 45:656–83

    CAS  Google Scholar 

  66. Selby PJ, Driver MV (1977) An unusual cause of apparent epilepsy: EKG and EEG findings in a case of Jervell Lange-Neilson syndrome. J Neurol Neurosurg Psychiatry 40:1102–108

    Article  CAS  PubMed  Google Scholar 

  67. Smaje JC, Davidson C, Teasdale GM (1987) Sino-atrial arrest due to temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 50:112–13

    Article  CAS  PubMed  Google Scholar 

  68. Spratling WP (1902) The cause and manner of death in epilepsy. Med News 80:1225–227

    Google Scholar 

  69. Stollberger C, Finsterer J (2004) Cardiorespiratory findings in sudden unexplained/unexpected death in epilepsy (SUDEP). Epilepsy Res 59:51–0

    Article  PubMed  Google Scholar 

  70. Terrence CF, Rao GR, Perper TA (1981) Neurogenic pulmonary edema in unexpected unexplained death of epileptic patients. Ann Neurol 9:458–64

    Article  CAS  PubMed  Google Scholar 

  71. Terrence CF, Wisotzkey HM, Perper TA (1975) Unexpected, unexplained death in epileptic patients. Neurology 25:594–98

    PubMed  Google Scholar 

  72. Tigaran S, Molgaard H, Dam M (2002) Atrio-ventricular block: a possible explanation of sudden unexpected death in epilepsy. Acta Neurol Scand 106:229–33

    Article  CAS  PubMed  Google Scholar 

  73. Tigaran S, Molgaard H, McClelland R, Dam M, Jaffe AS (2003) Evidence of cardiac ischemia during seizures in drug refractory epilepsy patients. Neurology 60:492–95

    CAS  PubMed  Google Scholar 

  74. Tinuper P, Bisulli F, Cerullo A, Carcangiu R, Marini C, Pierangeli G, Cortelli P (2001) Ictal bradycardia in partial epileptic seizures: Autonomic investigation in three cases and literature review. Brain 124:2361–371

    Article  CAS  PubMed  Google Scholar 

  75. Van Buren J (1958) Some autonomic concomitants of ictal automatism. A study of temporal lobe attacks. Brain LXXXI:505–28

    Google Scholar 

  76. Walsh GO, Masland W, Goldensohn E (1972) Relationship between paroxysmal atrial tachycardia and paroxysmal cerebral discharges. Bull L A Neurol Assoc 37:28–5

    CAS  Google Scholar 

  77. Ward OC (1964) A new familial cardiac syndrome in children. J Irish Med Assoc 54:103–06

    CAS  Google Scholar 

  78. Wilder-Smith E (1992) Complete atrioventricular conduction block during complex partial seizure. J Neurol Neurosurg Psychiatry 55:734–36

    Article  CAS  PubMed  Google Scholar 

  79. Winans HM (1949) Epileptic equivalents, a cause of somatic symptoms. Am J Med 7:150–52

    Article  CAS  PubMed  Google Scholar 

  80. Woodruff BK, Britton JW, Tigaran S, Cascino GD, Burritt MF, McConnell JP, Ravkilde J, Molgaard H,Andreasen F, Dam M, Jaffe AS (2003) Cardiac troponin levels following monitored epileptic seizures. Neurology 60:1690–692

    CAS  PubMed  Google Scholar 

  81. Zijlmans M, Flanagan D, Gotman J (2002) Heart rate changes and ECG abnormalities during epileptic seizures: prevalence and definition of an objective clinical sign. Epilepsia 43:847–54

    Article  PubMed  Google Scholar 

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Freeman, R. Cardiovascular manifestations of autonomic epilepsy. Clin Auton Res 16, 12–17 (2006). https://doi.org/10.1007/s10286-006-0278-y

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