CRITICAL REVIEW AND INVITED COMMENTARY
Autonomic alterations and cardiac changes in epilepsy
Version of Record online: 7 JAN 2010
Wiley Periodicals, Inc. © 2010 International League Against Epilepsy
Volume 51, Issue 5, pages 725–737, May 2010
How to Cite
Sevcencu, C. and Struijk, J. J. (2010), Autonomic alterations and cardiac changes in epilepsy. Epilepsia, 51: 725–737. doi: 10.1111/j.1528-1167.2009.02479.x
- Issue online: 22 APR 2010
- Version of Record online: 7 JAN 2010
- Accepted November 6, 2009; Early View publication January 7, 2010.
Studies with heart rate variability have revealed interictal autonomic alterations in patients with epilepsy. In addition, epilepsy is frequently associated with ictal tachycardia or bradycardia, which sometimes precedes the onset of seizures. Ictal tachycardia is sometimes associated with electrocardiography (ECG) morphologic changes and ictal bradycardia often progresses to asystole. Such cardiac manifestations of seizures have been hypothesized as possible causes for sudden unexplained death in epilepsy (SUPEP). The present review relates to interictal and ictal cardiac manifestations of epilepsy with focus on heart rate, heart rate variability, and ECG changes. Aspects of the supporting mechanisms are discussed and attention is drawn to the interaction between central and peripheral effects, interictal autonomic conditions, ictal autonomic discharges, and administration of antiepileptic drugs in shaping the ictal cardiac changes. Because these interactions are complex and not totally understood, closer surveillance of patients and more experimental work is necessary to elucidate the mechanistic support of autonomic and cardiac changes in epilepsy, and to design better strategies to avoid their undesirable effects. It is also suggested that some of these changes could be used as predictors or markers for the onset of seizures.