癫痫增加心脏骤停风险

一项包含1,019例心源性猝死患者的病例对照研究显示，癫痫可使心源性猝死风险增加2倍。

 “癫痫患者中，有很大一部分发生猝死，”阿姆斯特丹大学的Abdennasser Bardai博士及其同事说。癫痫和心脏骤停(SCA)都是病理性电活动造成的，但对癫痫患者的SCA尚无深入研究。

为此，研究者对2005年7月~2010年1月期间进行的阿姆斯特丹研究(ARREST)的数据进行了回顾。将1,019个SCA病例与2,834例对照相匹配。病例患者的平均年龄为64岁，对照患者的平均年龄为58岁，并且研究人群中约70%为男性患者(PLoS ONE 7:e4274 [doi:10.1371/journal.pone.0042749])。

结果显示，共有12例SCA患者(1.4%)和12例对照(0.4%)被诊断为活动性癫痫。经校正心脏缺血、糖尿病和心力衰竭后，发现癫痫个体发生SCA的风险接近对照的3倍(比值比为2.9)。一项亚组分析显示，年龄<50岁的癫痫个体发生SCA的风险高于年龄50岁的癫痫个体，女性癫痫患者发生SCA的风险高于男性。已明确的SCA危险因素(包括高血压、糖尿病、心力衰竭和高胆固醇血症)也是这项研究中的危险因素。

癫痫意外猝死(SUDEP)“最常见于慢性癫痫、癫痫发作控制较差、多种抗癫痫药治疗、发病年龄低和癫痫病史长的人群，”研究者写道。“我们的研究结果可能提示，将来自心脏原因的SCA风险扩大到SUDEP之外的癫痫患者。”尽管结果提示SCA可能导致SUDEP，但无法排除 其他原因，如呼吸抑制。在12例癫痫患者发生的SCA中，有11例患者在SCA之前未发现癫痫发作征兆。

Bardai博士披露无相关利益冲突。

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By: HEIDI SPLETE, Cardiology News Digital Network

Epilepsy increased the risk for sudden cardiac death threefold in a case-control study involving 1,019 cases of sudden cardiac death.

"A substantial portion of deaths in epilepsy happen suddenly," said Dr. Abdennasser Bardai of the University of Amsterdam and his colleagues. Both epilepsy and sudden cardiac arrest (SCA) are caused by pathological electrical activity, but the risk for SCA in epilepsy patients has not been well studied, they noted.

The researchers reviewed data from the Amsterdam Resuscitation Studies (ARREST) conducted between July 2005 and January 2010. They matched 1,019 cases of SCA with 2,834 controls. The average age of the patients was 64 years for cases and 58 years for controls, and the study population was about 70% male (PLoS ONE 7:e4274 [doi:10.1371/journal.pone.0042749]).

Overall, 12 SCA cases (1.4%) and 12 controls (0.4%) had an active epilepsy diagnosis. Individuals with epilepsy had nearly three times greater odds for having SCA than did controls (odds ratio, 2.9) after adjustment for cardiac ischemia, diabetes, and heart failure.

In a subanalysis, SCA risk was increased in individuals with epilepsy younger than 50 years, compared with those aged 50 years and older, and in women compared with men. Established risk factors for SCA, including hypertension, diabetes mellitus, heart failure, and hypercholesterolemia, also were risk factors in this study, the researchers noted.

Sudden unexpected death in epilepsy (SUDEP) "most frequently occurs in people with chronic epilepsy, poor seizure control, antiepileptic drug polytherapy, young age of onset, and a long history of epilepsy," the researchers wrote. "Our findings may suggest that the risk for SCA from cardiac causes extends to people with epilepsy beyond those with SUDEP," they added.

Although the findings suggest that SCA may contribute to SUDEP, other causes, such as respiratory depression, cannot be ruled out, the researchers said. In 11 of the 12 cases of SCA in epilepsy patients, no sign of seizure activity was noted before the SCA. The study was limited by the small number of individuals with active epilepsy who had SCA, and more research is needed to determine the causes of SCA risk in patients with epilepsy, the researchers added.

But the findings are "the first systematically collected evidence from a community-based study that epilepsy in the general population is associated with an increased risk for SCA," they wrote.

Dr. Bardai had no financial conflicts to disclose.