de Sousa Jorge Murilo Barbosa, Fialho Guilherme Loureiro, Wolf Peter, Walz Roger, Lin Katia
Programa de Pós-Graduação em Cuidados Intensivos e Paliativos, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
Serviço de Cardiologia, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
Epilepsy Res. 2017 Jan;129:106-116. doi: 10.1016/j.eplepsyres.2016.12.011. Epub 2016 Dec 20.
Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in young patients with epilepsy (PWE). Although its mechanisms are still poorly understood, they may include cardiorespiratory dysfunction. Standard 12-lead electrocardiograms (ECGs) were obtained from 62 consecutive patients (aged 18-66y) with a definite diagnosis of epilepsy, without seizures at the day of ECG, and 57 healthy controls matched for sex, age and body mass index (BMI). All ECGs were evaluated by a blinded board-certified cardiologist. Patients with symptomatic focal epilepsy represented 90.3% (N=56), of whom 56.4% (N=35) had temporal lobe epilepsy, with a mean duration of 22.02±14.96years of epilepsy. We observed more prolonged P-wave (p<0.0001) and PR interval (p=0.01) in patients than in controls. Additionally, longer QT intervals (p<0.01), pathologic QT dispersion (p<0.01) and left atrial overload (p<0.01) were more common in PWE. Multiple linear regression analysis evidenced age, gender and polytherapy as factors associated with altered ECG. Therefore, routine ECG should be requested in PWE, especially for males, increasing age and in polytherapy. Findings such as longer PR and QT interval, and pathologic QT dispersion, may reflect cardiac structural changes and/or autonomic nervous system dysfunction and indicate a risk for SUDEP.
癫痫性猝死（SUDEP）是年轻癫痫患者（PWE）死亡的主要原因。尽管其机制仍知之甚少，但可能包括心肺功能障碍。对62例确诊为癫痫且在心电图检查当天无癫痫发作的连续患者（年龄18 - 66岁）以及57例性别、年龄和体重指数（BMI）相匹配的健康对照者进行了标准12导联心电图（ECG）检查。所有心电图均由一位不知情的经过委员会认证的心脏病专家进行评估。症状性局灶性癫痫患者占90.3%（N = 56），其中56.4%（N = 35）患有颞叶癫痫，癫痫平均病程为22.02±14.96年。我们观察到患者的P波（p<0.0001）和PR间期（p = 0.01）比对照组更长。此外，较长的QT间期（p<0.01）、病理性QT离散度（p<0.01）和左心房负荷过重（p<0.01）在PWE中更为常见。多元线性回归分析表明年龄、性别和联合治疗是与心电图改变相关的因素。因此，PWE应常规进行心电图检查，尤其是男性、年龄较大者和接受联合治疗者。PR和QT间期延长以及病理性QT离散度等发现可能反映心脏结构变化和/或自主神经系统功能障碍，并提示SUDEP风险。
