Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, 53127 Bonn, Germany.
Stichting Epilepsie Instellingen Nederland - SEIN, Achterweg 5, 2103 SW, Heemstede, The Netherlands, NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK.
Epileptic Disord. 2021 Feb 1;23(1):17-39. doi: 10.1684/epd.2021.1254.
People with epilepsy have a three-fold increased risk of dying prematurely, and a significant proportion is due to sudden cardiac death or acute myocardial infarctions. The causes of increased cardiovascular morbidity and mortality in epilepsy are manifold and include acute or remote effects of epileptic seizures, the longstanding epilepsy itself or antiseizure treatments. Seizure-related cardiac arrhythmias are common and comprise bradyarrhythmia and asystole, atrial fibrillation and ventricular tachycardia. The most frequent clinically relevant seizure-related arrhythmia is ictal asystole that may require implantation of a cardiac pacemaker, whereas seizure-related ventricular tachycardias are only rarely reported. Takotsubo cardiomyopathy and myocardial infarction are rare complications and predominantly described in association with tonic-clonic seizures. Epilepsy-related cardiac complications include a disturbed cardiac autonomic nervous system and acquired dysfunction of the heart (recently defined as 'epileptic heart'), probably contributing to the abnormalities of cardiac repolarisation and elevated risk of sudden cardiac death in people with epilepsy. If successful, the use of antiseizure medication prevents seizure-related cardiac arrhythmias and remote cardiac complications. However, enzyme-inducing antiseizure medications have a negative impact on cardiovascular risk factors, which may further be aggravated by weight gain linked to specific antiseizure drugs. Given the severe consequences of cardiac risks, the aim of this educational review is to explain the many facets of cardiac complications and their underlying causes, and to enable the reader to recognize and manage these risks with the goal to mitigate the cardiac risks in people with epilepsy. Features of syncope are explained in detail, as syncope of all origins can be mistaken as epileptic seizures in people with or without epilepsy, and ictal syncope (i.e. seizure-induced syncope) can easily be ignored.
患有癫痫的人过早死亡的风险增加了三倍，其中相当一部分是由于心脏性猝死或急性心肌梗死。癫痫导致心血管发病率和死亡率增加的原因有很多，包括癫痫发作的急性或远期影响、长期存在的癫痫本身或抗癫痫治疗。与癫痫发作相关的心律失常很常见，包括心动过缓或停搏、心房颤动和室性心动过速。最常见的与癫痫发作相关的临床相关心律失常是癫痫发作时的心动过缓，可能需要植入心脏起搏器，而与癫痫发作相关的室性心动过速则很少报道。应激性心肌病和心肌梗死是罕见的并发症，主要与强直阵挛性癫痫发作有关。癫痫相关的心脏并发症包括心脏自主神经系统紊乱和心脏获得性功能障碍（最近被定义为“癫痫性心脏病”），这可能导致心脏复极异常和癫痫患者发生心源性猝死的风险增加。如果成功的话，抗癫痫药物的使用可以预防与癫痫发作相关的心律失常和远程心脏并发症。然而，酶诱导型抗癫痫药物会对心血管危险因素产生负面影响，而特定抗癫痫药物引起的体重增加可能会进一步加重这种影响。鉴于心脏风险的严重后果，本教育性综述的目的是解释心脏并发症的许多方面及其潜在原因，并使读者能够识别和管理这些风险，以减轻癫痫患者的心脏风险。详细解释了晕厥的特征，因为所有起源的晕厥在有或没有癫痫的人中都可能被误认为是癫痫发作，而癫痫发作时的晕厥（即癫痫发作引起的晕厥）很容易被忽视。
