胃酸反流诱发喉痉挛作为癫痫猝死的一种潜在机制。
Acid reflux induced laryngospasm as a potential mechanism of sudden death in epilepsy.
作者信息
Budde Ryan B, Arafat Muhammad A, Pederson Daniel J, Lovick Thelma A, Jefferys John G R, Irazoqui Pedro P
机构信息
Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, US.
Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, US.
出版信息
Epilepsy Res. 2018 Dec;148:23-31. doi: 10.1016/j.eplepsyres.2018.10.003. Epub 2018 Oct 9.
OBJECTIVE
Recent research suggests that obstructive laryngospasm and consequent respiratory arrest may be a mechanism in sudden unexpected death in epilepsy. We sought to test a new hypothesis that this laryngospasm is caused by seizures driving reflux of stomach acid into the larynx, rather than spontaneous pathological activity in the recurrent laryngeal nerve.
APPROACH
We used an acute kainic acid model under urethane anesthesia to observe seizure activity in Long-Evans rats. We measured the pH in the esophagus and respiratory activity. In a subset of experiments, we blocked acid movement up the esophagus with a balloon catheter.
MAIN RESULTS
In all cases of sudden death, terminal apnea was preceded by a large pH drop from 7 to 2 in the esophagus. In several animals we observed acidic fluid exiting the mouth, sometimes in large quantities. In animals where acid movement was blocked, sudden deaths did not occur. No acid was detected in controls.
SIGNIFICANCE
The results suggest that acid movement up the esophagus is a trigger for sudden death in KA induced seizures. The fact that blocking acid also eliminates sudden death implies causation. These results may provide insight to the mechanism of SUDEP in humans.
目的
近期研究表明，梗阻性喉痉挛及随之而来的呼吸骤停可能是癫痫猝死的一种机制。我们试图验证一个新的假说，即这种喉痉挛是由癫痫发作促使胃酸反流至喉部所致，而非喉返神经的自发性病理活动。
方法
我们在乌拉坦麻醉下使用急性 kainic 酸模型观察 Long-Evans 大鼠的癫痫活动。我们测量了食管内的 pH 值和呼吸活动。在一部分实验中，我们用球囊导管阻断胃酸沿食管向上移动。
主要结果
在所有猝死病例中，终末期呼吸暂停之前食管内的 pH 值从 7 大幅降至2。在几只动物中，我们观察到酸性液体从口中流出，有时量还很大。在胃酸移动被阻断的动物中，未发生猝死。在对照组中未检测到胃酸。
意义
结果表明，胃酸沿食管向上移动是 KA 诱导的癫痫发作中猝死的触发因素。阻断胃酸也能消除猝死这一事实意味着存在因果关系。这些结果可能为人类癫痫猝死的机制提供见解。
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