ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 14 of 47
JMBS 2019, 4(1): 96–102
Clinical Medicine

Electrocardiography and Ultrasound Diagnostics in the Examination of Patients with Epilepsy and Cardiovascular Pathology

Grymailo V. 1, Litovchenko T. 2, Markova T. 1, Novikova A. 1, Romanenko A. 1

The study shows that the risk of myocardial infarction and stroke is increased in patients with epilepsy. The purpose of the study is to identify cardiac disorders in the early stages of patients with epilepsy and to assess the effect of antiepileptic treatment on the cardiovascular system (hereinafter – CVS). Material and methods. 50 patients with epilepsy without CVS pathology (group 1) and 56 patients with epilepsy and CVS pathology (group 2) were under observation. All patients underwent general clinical, neurological examination, ECG, echocardiogram, carotid ultrasound, EEG, and HRV. Results and discussion. Cardiac pathology in patients of the second group was represented by hypertensive disease (hereinafter – HD) stage I, II, III in 29 (57%) patients, coronary heart disease (hereinafter – CHD): stable exertional angina II A and II B functional classes in 6 (13%) patients, a combination of HD and CHD was found in 15 (30%) patients. The number of patients whose heart rate was less than 65 beats / min was significantly higher among patients taking carbamazepine compared with other antiepileptic drugs in both groups (p <0.05). It was found that the duration of the PQ interval was, on average, significantly higher in patients of the 2nd group taking valproate and carbamazepine when compared with patients of the 1st group receiving the above-mentioned antiepileptic drugs (p<0.02). Taking into account that the lengthening of the PQ interval is one of the predictors of the development of fatal arrhythmias, it is necessary to be cautious when using carbamazepine and valproic acid in patients with cardiovascular pathology. This was consistent with a decrease in HRV in patients receiving carbamazepine. When evaluating patients in both groups receiving carbamazepine, it was found out that with a decrease in heart rate, the duration of the QT interval increased mainly due to the PQ interval and, to a lesser extent, due to the QT and TP intervals. So with a decrease in heart rate for every 10 beats/min, the duration of the PQ interval increased on average by 6.2±2.3 ms in the first group and by 7.1±2.2 ms in the second group; the QT interval increased by 3 ± 1.5 ms in the first group, and by 2.5±1.1 ms in the second group; TP interval increased by 3.7±2.4 ms in the first group, and by 3.2±1.7 ms in the second group (p<0.05). A significantly longer duration of the PQ interval was also noted in patients of the second group receiving carbamazepine, compared with the first group (p<0.02). Among patients of group 2, the left ventricular ejection fraction was significantly lower in patients taking valproate compared with other antiepileptic drugs (p<0.05) The decrease in the left ventricular ejection fraction was accompanied by a predominance of humoral-metabolic level of regulation of cardiac activity, a decrease in the overall power of the HRV spectrum and sympathicotonia according to HRV. This may indicate a possible worsening of left ventricular myocardial dysfunction in patients with known cardiovascular pathology during valproate use. The obtained results showed that intima-media complex thickness was significantly higher in patients of both groups receiving valproate compared with patients taking lamotrigine, levetiracetam (p<0.001) and carbamazepine (p <0.05). Conclusion. In patients with epilepsy, an ECG should be performed before and after the starting to use antiepileptic drugs channel blockers due to the risk of arrhythmias. It is necessary to consider the possibility of negative inotropic action of valproate in patients with cardiovascular diseases. Valproic acid drugs may increase the risk of atherogenesis contributing to an increase in intima-media complex thickness.

Keywords: epilepsy, ECG, ultrasound diagnostics, cardiac disorders

Full text: PDF (Rus) 224K

  1. Ryvlin P, Nashef L, Lhatoo SD, Bateman LM, Bird J, Bleasel A, et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. The Lancet Neurology. 2013 Oct; 12(10): 966-77.
  2. Tomson T, Nashef L, Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions. The Lancet Neurology. 2008 Nov; 7(11): 1021-31.
  3. Karlov VA. Epilepsiya u detey i vzroslykh, zhenshchin i muzhchin. Rukovodstvo dlya vrachey. M: OAO «Izd-vo Meditsina »; 2010. 720 p. [Russian]
  4. Shorvon S. The treatment of epilepsy. Wiley-Blackwell: Oxford; 2009. 1200 p.
  5. So EL. What is known about the mechanisms underlying SUDEP? Epilepsia. 2008 Dec; 49(Suppl 9): 93-8.
  6. Olesen JB, Abildstrøm SZ, Erdal J, Gislason GH, Weeke P, Andersson C, et al. Effects of epilepsy and selected antiepileptic drugs on risk of myocardial infarction, stroke, and death in patients with or without previous stroke: a nationwide cohort study. Pharmacoepidemiology and Drug Safety. 2011; 20(9): 964-71.
  7. Chang CS, Liao CH, Lin CC, Lane HY, Sung FC, Kao CH. Patients with epilepsy are at an increased risk of subsequent stroke: A population-based cohort study. Seizure. 2014 May; 23(5): 377-81.
  8. Ota H, Kawamura Y, Sato N, Hasebe N. A Carbamazepine-induced Brugada-type Electrocardiographic Pattern in a Patient with Schizophrenia. Intern Med. 2017; 56(22): 3047-50.
  9. Sathyaprabha TN, Koot LAM, Hermans BHM, Adoor M, Sinha S, Kramer BW, et al. Effects of Chronic Carbamazepine Treatment on the ECG in Patients with Focal Seizures. Clin Drug Investig. 2018 Sep; 38(9): 845-51.
  10. Mańka-Gaca I, Łabuz-Roszak B, Machowska-Majchrzak A, Kalarus Z, Średniawa B, Pierzchała K. Interictal heart rate in patients with epilepsy. Wiad Lek. 2016; 69(3 pt 2): 443-8.
  11. Ishizue N, Niwano S, Saito M, Fukaya H, Nakamura H, Igarashi T, et al. Polytherapy with sodium channel-blocking antiepileptic drugs is associated with arrhythmogenic ST-T abnormality in patients with epilepsy. Seizure. 2016 Aug; 40: 81-7.
  12. Bardai A, Blom MT, van Noord C, Verhamme KM, Sturkenboom MC, Tan HL. Sudden cardiac death is associated both with epilepsy and with use of antiepileptic medications. Heart. 2015 Jan; 101(1): 17-22.