Vol 28, No 2 (2021)
Review Article
Published online: 2019-09-26

open access

Page views 2244
Article views/downloads 2487
Get Citation

Connect on Social Media

Connect on Social Media

Epilepsy and hypertension: The possible link for sudden unexpected death in epilepsy?

Patrycja J. Szczurkowska1, Katarzyna Polonis2, Christiane Becari3, Michał Hoffmann1, Krzysztof Narkiewicz1, Marzena Chrostowska1
Pubmed: 31565791
Cardiol J 2021;28(2):330-335.

Abstract

Epilepsy affects about 50 million people worldwide. Sudden unexpected death in epilepsy (SUDEP) is the main cause of death in epilepsy accounting for up to 17% of all deaths in epileptic patients, and therefore remains a major public health problem. SUDEP likely arises from a combination and interaction of multiple risk factors (such as being male, drug resistance, frequent generalized tonic-clonic seizures) making risk prediction and mitigation challenging. While there is a general understanding of the physiopathology of SUDEP, mechanistic hypotheses linking risk factors with a risk of SUDEP are still lacking. Identifying cross-talk between biological systems implicated in SUDEP may facilitate the development of improved models for SUDEP risk assessment, treatment and clinical management. In this review, the aim was to explore an overlap between the pathophysiology of hypertension, cardiovascular disease and epilepsy, and discuss its implication for SUDEP. Presented herein, evidence in literature in support of a cross-talk between the renin–angiotensin system (RAS) and sympathetic nervous system, both known to be involved in the development of hypertension and cardiovascular disease, and as one of the underlying mechanisms of SUDEP. This article also provides a brief description of local RAS in brain neuroinflammation and the role of centrally acting RAS inhibitors in epileptic seizure alleviation.

Article available in PDF format

View PDF Download PDF file

References

  1. Zhuo L, Zhang Y, Zielke HR, et al. Sudden unexpected death in epilepsy: Evaluation of forensic autopsy cases. Forensic Sci Int. 2012; 223(1-3): 171–175.
  2. Manolis TA, Manolis AA, Melita H, et al. Sudden unexpected death in epilepsy: The neuro-cardio-respiratory connection. Seizure. 2019; 64: 65–73.
  3. Pereira MG, Becari C, Oliveira JAC, et al. Inhibition of the renin-angiotensin system prevents seizures in a rat model of epilepsy. Clin Sci (Lond). 2010; 119(11): 477–482.
  4. Shimada T, Takemiya T, Sugiura H, et al. Role of inflammatory mediators in the pathogenesis of epilepsy. Mediators Inflamm. 2014; 2014: 901902.
  5. Sun H, Wu H, Yu X, et al. Angiotensin II and its receptor in activated microglia enhanced neuronal loss and cognitive impairment following pilocarpine-induced status epilepticus. Mol Cell Neurosci. 2015; 65: 58–67.
  6. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014; 55(4): 475–482.
  7. Stafstrom C, Carmant L, et al. Seizures and epilepsy: An overview for neuroscientists. Cold Spring Harb Perspect Med. 2015; 5(6): 1–18.
  8. Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Zeitschrift fur Epileptol. 2018; 31(4): 272–281.
  9. Leitinger M, Trinka E, Giovannini G, et al. Epidemiology of status epilepticus in adults: A population-based study on incidence, causes, and outcomes. Epilepsia. 2019; 60(1): 53–62.
  10. Ruthirago D, Julayanont P, Karukote A, et al. Sudden unexpected death in epilepsy: ongoing challenges in finding mechanisms and prevention. Int J Neurosci. 2018; 128(11): 1052–1060.
  11. Surges R, Thijs RD, Tan HL, et al. Sudden unexpected death in epilepsy: risk factors and potential pathomechanisms. Nat Rev Neurol. 2009; 5(9): 492–504.
  12. Devinsky O, Hesdorffer DC, Thurman DJ, et al. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol. 2016; 15(10): 1075–1088.
  13. Holst AG, Winkel BoG, Risgaard B, et al. Epilepsy and risk of death and sudden unexpected death in the young: a nationwide study. Epilepsia. 2013; 54(9): 1613–1620.
  14. Ryvlin P, Nashef L, Lhatoo SD, et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. Lancet Neurol. 2013; 12(10): 966–977.
  15. Finsterer J, Wahbi K. CNS-disease affecting the heart: brain-heart disorders. J Neurol Sci. 2014; 345(1-2): 8–14.
  16. Priori SG, Aliot E, Blømstrom-Lundqvist C, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J. 2001; 22(16): 1374–1450.
  17. Devinsky O. Effects of seizures on autonomic and cardiovascular function. Epilepsy Curr . 2004; 4(2): x43–46.
  18. Ravindran K, Powell KL, Todaro M, et al. The pathophysiology of cardiac dysfunction in epilepsy. Epilepsy Res. 2016; 127: 19–29.
  19. Powell KL, Jones NC, Kennard JT, et al. HCN channelopathy and cardiac electrophysiologic dysfunction in genetic and acquired rat epilepsy models. Epilepsia. 2014; 55(4): 609–620.
  20. Stöllberger C, Finsterer J. Cardiorespiratory findings in sudden unexplained/unexpected death in epilepsy (SUDEP). Epilepsy Res. 2004; 59(1): 51–60.
  21. Elger CE, Schmidt D. Modern management of epilepsy: a practical approach. Epilepsy Behav. 2008; 12(4): 501–539.
  22. Williams B, Mancia G, Spiering W, et al. 2018 ESC / ESH Guidelines for the management of arterial hypertension. ; 2018: 1–98.
  23. Yoon SS, Carroll MD, Fryar CD. Hypertension prevalence and control among adults: United States, 2011-2014. NCHS Data Brief. 2015; 220: 1–8.
  24. De Venecia T, Lu M, Figueredo VM. Hypertension in young adults. Postgrad Med. 2016; 128(2): 201–207.
  25. Iwanami J, Mogi M, Iwai M, et al. Inhibition of the renin-angiotensin system and target organ protection. Hypertens Res. 2009; 32(4): 229–237.
  26. Stupin A, Drenjancevic I, Rasic L, et al. A cross-talk between the renin-angiotensin and adrenergic systems in cardiovascular health and disease. Southeast Eur Med J. 2017; 1(1): 90–107.
  27. Neves MF, Cunha AR, Cunha MR, et al. The role of renin-angiotensin-aldosterone system and its new components in arterial stiffness and vascular aging. High Blood Press Cardiovasc Prev. 2018; 25(2): 137–145.
  28. Grassi G, Allyn M, Murray E, et al. The Sympathetic Nervous System alteration in human hypertension. 2016; 116(6): 976–90.
  29. Tsuda K. Renin-Angiotensin system and sympathetic neurotransmitter release in the central nervous system of hypertension. Int J Hypertens. 2012; 2012: 474870.
  30. Wilner AN, Sharma BK, Soucy A, et al. Common comorbidities in women and men with epilepsy and the relationship between number of comorbidities and health plan paid costs in 2010. Epilepsy Behav. 2014; 32: 15–20.
  31. Tchekalarova JD, Ivanova N, Atanasova D, et al. Long-Term treatment with losartan attenuates seizure activity and neuronal damage without affecting behavioral changes in a model of co-morbid hypertension and epilepsy. Cell Mol Neurobiol. 2016; 36(6): 927–941.
  32. Tchekalarova J, Loyens E, Smolders I. Effects of AT1 receptor antagonism on kainate-induced seizures and concomitant changes in hippocampal extracellular noradrenaline, serotonin, and dopamine levels in Wistar-Kyoto and spontaneously hypertensive rats. Epilepsy Behav. 2015; 46: 66–71.
  33. McKinley MJ, Albiston AL, Allen AM, et al. The brain renin-angiotensin system: location and physiological roles. Int J Biochem Cell Biol. 2003; 35(6): 901–918.
  34. Pereira MG, Souza LL, Becari C, et al. Angiotensin II-independent angiotensin-(1-7) formation in rat hippocampus: involvement of thimet oligopeptidase. Hypertension. 2013; 62(5): 879–885.
  35. Wright JW, Harding JW. The brain renin-angiotensin system: a diversity of functions and implications for CNS diseases. Pflugers Arch. 2013; 465(1): 133–151.
  36. Saavedra JM, Sánchez-Lemus E, Benicky J. Blockade of brain angiotensin II AT1 receptors ameliorates stress, anxiety, brain inflammation and ischemia: Therapeutic implications. Psychoneuroendocrinology. 2011; 36(1): 1–18.
  37. De Bundel D, Smolders I, Vanderheyden P, et al. Ang II and Ang IV: unraveling the mechanism of action on synaptic plasticity, memory, and epilepsy. CNS Neurosci Ther. 2008; 14(4): 315–339.
  38. Ibrahim MA, Koorbanally NA, Islam MS. In vitro anti-oxidative activities of the various parts of Parkia biglobosa and GC-MS analysis of extracts with high activity. Afr J Tradit Complement Altern Med [Internet]. Afr J Tradit Complement Altern Med. 2013; 10(5): 283–291.
  39. Bar-Klein G, Cacheaux LP, Kamintsky L, et al. Losartan prevents acquired epilepsy via TGF-β signaling suppression. Ann Neurol. 2014; 75(6): 864–875.
  40. Gouveia TL, Frangiotti MI, de Brito JM, et al. The levels of renin-angiotensin related components are modified in the hippocampus of rats submitted to pilocarpine model of epilepsy. Neurochem Int. 2012; 61(1): 54–62.