Agenzia Regionale di Sanità, Regione Toscana, Firenze, Italy.
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
Epilepsy Behav. 2019 Aug;97:304-312. doi: 10.1016/j.yebeh.2019.05.038. Epub 2019 Jul 3.
Epilepsy is often comorbid with either neurological or nonneurological diseases. The association between epilepsy and cardiac arrhythmias is not infrequent, mostly in patients with severe forms of epilepsy or critically ill. Remarkably, these medical conditions share many similarities. Vascular and genetic disorders may predispose to both seizures and abnormalities of cardiac electrophysiology. Repeated and uncontrolled seizures may favor potentially life-threatening arrhythmias. Antiepileptic drugs (AEDs) may facilitate the occurrence of cardiac arrhythmias by acting on ionic channels at heart level. Antiarrhythmic drugs (AADs) can have effects on ionic channels expressed in the brain, as suggested by their efficacy in treating patients with rare forms of epilepsy; AADs may also be proconvulsant, mainly during their overdosage. In clinical practice, the AEDs with the lowest risk to influence cardiac electrophysiology are to be preferred in patients presenting with either seizures or arrhythmias. Traditional AEDs should be avoided because of their arrhythmogenic properties and enzyme-inducing effects, which may make ineffective the concomitant treatment with AADs. Some of the newer AEDs can rarely affect cardiac rhythm, and electrocardiogram (ECG) monitoring should be warranted.
癫痫常与神经或非神经疾病并存。癫痫与心律失常的关联并不罕见，主要见于严重癫痫或病危患者。值得注意的是，这些病症有许多相似之处。血管和遗传疾病可能使癫痫发作和心脏电生理异常更容易发生。反复发作且不受控制的癫痫发作可能有利于潜在的危及生命的心律失常。抗癫痫药物（AEDs）通过作用于心脏水平的离子通道，可能促进心律失常的发生。抗心律失常药物（AADs）可能对大脑中表达的离子通道产生影响，这与其在治疗罕见形式癫痫患者中的疗效一致；AADs 也可能是致痫的，主要是在药物过量时。在临床实践中，在既有癫痫发作又有心律失常的患者中，应首选对心脏电生理影响最小的 AEDs。由于具有致心律失常和酶诱导作用，传统 AEDs 应避免使用，因为这可能使同时使用 AADs 无效。一些新型 AEDs 可能很少影响心脏节律，因此需要进行心电图（ECG）监测。
