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The Role of Heart and Brain in the Loss of Consciousness: Best Frenemies?

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 5381

Special Issue Editors

Dr. Elena Pasini

E-Mail Website
Guest Editor
Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
Interests: epilepsy surgery; neurophysiology in intensive care unit; status epilepticus
Prof. Dr. Roberto Michelucci

E-Mail Website
Guest Editor
Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
Interests: epilepsy; neurophysiology

Special Issue Information

Dear Colleagues,

Since ancient times, physicians have been fascinated by the complex and heterogeneous interaction between the heart and brain. The supremacy of one over the other was differently established during the epochs. The most frequent heart–brain pathology is the loss of consciousness which, with a lifetime prevalence of 50% in the general population, is one of the most common medical problems. Seizures, syncopes, and psychogenic non-epileptic seizures (PNES) account for about 90% of loss-of-consciousness cases. The limbic system is the common thread of many of these conditions, justifying situational syncope as well as focal epileptic seizures with arrhythmia. However, the constellation of different loss of consciousness mechanisms is much more varied, holding the greatest surprises, including syncope-induced seizures, arrhythmias that induce ictal-like symptoms, and arrhythmias or seizure-induced heart diseases. If this were not enough, recent studies on heart rate variability in epileptic patients have documented its relevance in predicting seizures.

In this Special Issue, we welcome the submission of clinical research, articles, and reviews aimed at elucidating the clinical updates underlying the brain–heart relationship and speeding up the diagnosis and management of these patients.

Dr. Elena Pasini
Prof. Dr. Roberto Michelucci
Guest Editors

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Keywords

  •  loss of consciousness
  •  epilepsy
  •  ictal arrhythmia
  •  ictal asystole
  •  heart rate variability

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Published Papers (3 papers)

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Research

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12 pages, 1739 KiB  
Article
Ictal Bradycardia and Asystole in Sleep-Related Hypermotor Epilepsy: A Study of 200 Patients
by Lorenzo Muccioli, Giulia Bruschi, Lorenzo Ferri, Anna Scarabello, Lisa Taruffi, Lidia Di Vito, Barbara Mostacci, Federica Provini, Giovanna Calandra-Buonaura, Paolo Tinuper, Laura Licchetta and Francesca Bisulli
J. Clin. Med. 2024, 13(6), 1767; https://doi.org/10.3390/jcm13061767 - 19 Mar 2024
Viewed by 1084
Abstract
Background: Ictal bradycardia (IB) and asystole (IA) represent a rare but potentially harmful feature of epileptic seizures. The aim of this study was to study IB/IA in patients with sleep-related hypermotor epilepsy (SHE). Methods: We retrospectively included cases with video-EEG-confirmed SHE [...] Read more.
Background: Ictal bradycardia (IB) and asystole (IA) represent a rare but potentially harmful feature of epileptic seizures. The aim of this study was to study IB/IA in patients with sleep-related hypermotor epilepsy (SHE). Methods: We retrospectively included cases with video-EEG-confirmed SHE who attended our Institute up to January 2021. We reviewed the ictal polysomnography recordings focusing on ECG and identified cases with IB (R-R interval ≥ 2 s or a ≥10% decrease of baseline heart rate) and IA (R-R interval ≥ 4 s). Results: We included 200 patients (123 males, 61.5%), with a mean age of 42 ± 16 years. Twenty patients (20%) had focal cortical dysplasia (FCD) on brain MRI. Eighteen (out of 104 tested, 17.3%) carried pathogenic variants (mTOR pathway, n = 10, nAchR subunits, n = 4, KCNT1, n = 4). We identified IB/IA in four cases (2%): three had IA (mean 10 s) and one had IB. Three patients had FCD (left fronto-insular region, left amygdala, right mid-temporal gyrus) and two had pathogenic variants in DEPDC5; both features were more prevalent in patients with IB/IA than those without (p = 0.003 and p = 0.037, respectively). Conclusions: We identified IB/IA in 2% of patients with SHE and showed that this subgroup more frequently had FCD on brain MRI and pathogenic variants in genes related to the mTOR pathway. Full article
(This article belongs to the Special Issue The Role of Heart and Brain in the Loss of Consciousness: Best Frenemies?)
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14 pages, 932 KiB  
Article
Exploring Autonomic Alterations during Seizures in Temporal Lobe Epilepsy: Insights from a Heart-Rate Variability Analysis
by Sung-Min You, Baek-Hwan Cho, Hyo-Eun Bae, Young-Kyun Kim, Jae-Rim Kim, Soo-Ryun Park, Young-Min Shon, Dae-Won Seo and In-Young Kim
J. Clin. Med. 2023, 12(13), 4284; https://doi.org/10.3390/jcm12134284 - 26 Jun 2023
Cited by 1 | Viewed by 1778
Abstract
Epilepsy’s impact on cardiovascular function and autonomic regulation, including heart-rate variability, is complex and may contribute to sudden unexpected death in epilepsy (SUDEP). Lateralization of autonomic control in the brain remains the subject of debate; nevertheless, ultra-short-term heart-rate variability (HRV) analysis is a [...] Read more.
Epilepsy’s impact on cardiovascular function and autonomic regulation, including heart-rate variability, is complex and may contribute to sudden unexpected death in epilepsy (SUDEP). Lateralization of autonomic control in the brain remains the subject of debate; nevertheless, ultra-short-term heart-rate variability (HRV) analysis is a useful tool for understanding the pathophysiology of autonomic dysfunction in epilepsy patients. A retrospective study reviewed medical records of patients with temporal lobe epilepsy who underwent presurgical evaluations. Data from 75 patients were analyzed and HRV indices were extracted from electrocardiogram recordings of preictal, ictal, and postictal intervals. Various HRV indices were calculated, including time domain, frequency domain, and nonlinear indices, to assess autonomic function during different seizure intervals. The study found significant differences in HRV indices based on hemispheric laterality, language dominancy, hippocampal atrophy, amygdala enlargement, sustained theta activity, and seizure frequency. HRV indices such as the root mean square of successive differences between heartbeats, pNN50, normalized low-frequency, normalized high-frequency, and the low-frequency/high-frequency ratio exhibited significant differences during the ictal period. Language dominancy, hippocampal atrophy, amygdala enlargement, and sustained theta activity were also found to affect HRV. Seizure frequency was correlated with HRV indices, suggesting a potential relationship with the risk of SUDEP. Full article
(This article belongs to the Special Issue The Role of Heart and Brain in the Loss of Consciousness: Best Frenemies?)
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Review

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13 pages, 6423 KiB  
Review
The Heart and Seizures: Friends or Enemies?
by Elena Pasini and Roberto Michelucci
J. Clin. Med. 2023, 12(18), 5805; https://doi.org/10.3390/jcm12185805 - 6 Sep 2023
Cited by 1 | Viewed by 1804
Abstract
The heart and seizures are closely linked by an indissoluble relationship that finds its basis in the cerebral limbic circuit whose mechanisms remain largely obscure. The differential diagnosis between seizures and syncopes has always been a cornerstone of the collaboration between cardiologists and [...] Read more.
The heart and seizures are closely linked by an indissoluble relationship that finds its basis in the cerebral limbic circuit whose mechanisms remain largely obscure. The differential diagnosis between seizures and syncopes has always been a cornerstone of the collaboration between cardiologists and neurologists and is renewed as a field of great interest for multidisciplinary collaboration in the era of the diffusion of prolonged telemonitoring units. The occurrence of ictal or post-ictal arrhythmias is currently a cause of great scientific debate with respect to the role and risks that these complications can generate (including sudden unexpected death in epilepsy). Furthermore, the study of epileptic seizures and the arrhythmological complications they cause (during and after seizures) also allows us to unravel the mechanisms that link them. Finally, intercritical arrhythmias may represent great potential in terms of the prevention of cardiological risk in epileptic patients as well as in the possible prediction of the seizures themselves. In this paper, we review the pertaining literature on this subject and propose a scheme of classification of the cases of arrhythmia temporally connected to seizures. Full article
(This article belongs to the Special Issue The Role of Heart and Brain in the Loss of Consciousness: Best Frenemies?)
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