Journal Article10.1038/S41582-021-00574-W
Autonomic manifestations of epilepsy: emerging pathways to sudden death?
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TL;DR: In this paper, a spectrum and diagnostic value of the mostly benign and self-limiting autonomic manifestations of epilepsy was reviewed, focusing on presentations that could contribute to sudden unexpected death in epilepsy.
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Abstract: Epileptic networks are intimately connected with the autonomic nervous system, as exemplified by a plethora of ictal (during a seizure) autonomic manifestations, including epigastric sensations, palpitations, goosebumps and syncope (fainting). Ictal autonomic changes might serve as diagnostic clues, provide targets for seizure detection and help us to understand the mechanisms that underlie sudden unexpected death in epilepsy (SUDEP). Autonomic alterations are generally more prominent in focal seizures originating from the temporal lobe, demonstrating the importance of limbic structures to the autonomic nervous system, and are particularly pronounced in focal-to-bilateral and generalized tonic–clonic seizures. The presence, type and severity of autonomic features are determined by the seizure onset zone, propagation pathways, lateralization and timing of the seizures, and the presence of interictal autonomic dysfunction. Evidence is mounting that not all autonomic manifestations are linked to SUDEP. In addition, experimental and clinical data emphasize the heterogeneity of SUDEP and its infrequent overlap with sudden cardiac death. Here, we review the spectrum and diagnostic value of the mostly benign and self-limiting autonomic manifestations of epilepsy. In particular, we focus on presentations that are likely to contribute to SUDEP and discuss how wearable devices might help to prevent SUDEP. The close connection between epileptic networks and the autonomic nervous system is illustrated by a range of autonomic manifestations during a seizure. This article reviews the spectrum and diagnostic value of these manifestations, focusing on presentations that could contribute to sudden unexpected death in epilepsy.
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References
2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)
TL;DR: In this article, the authors proposed AMIOdarone versus implantable cardioverter-defibrillator (ICD-DV) for the treatment of atrial fibrillation.
Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)
TL;DR: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means.
2018 ESC Guidelines for the diagnosis and management of syncope.
Michele Brignole,Angel Moya,Frederik J. de Lange,Jean-Claude Deharo,Perry M. Elliott,Alessandra Fanciulli,Artur Fedorowski,Raffaello Furlan,Rose Anne Kenny,Alfonso Martín,Vincent Probst,Matthew J. Reed,Ciara Rice,Richard Sutton,Andrea Ungar,J. Gert van Dijk +15 more
TL;DR: Authors/Task Force Members: Michele Brignole* (Chairperson), Angel Moya* (Co-chairperson) (Spain), Frederik J. de Lange (The Netherlands), Jean-Claude Deharo (France), Perry M. Elliott (UK), Alessandra Fanciulli (Austria), Artur Fedorowski (Sweden), Raffaello Furlan (Italy), Rose Anne Kenny (Ireland), Alfonso Mart ın (Spain
Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): A retrospective study
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TL;DR: Cardiorespiratory data showed a consistent and previously unrecognised pattern whereby rapid breathing developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiore Spiratory dysfunction, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal.
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TL;DR: This companion paper to the introduction of the International League Against Epilepsy (ILAE) 2017 classification of seizure types provides guidance on how to employ the classification, and a “users’ manual” for the ILAE 2017 will assist the adoption of the new system.
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