Pharmacological predictors of heart rate and conductivity disorders in juvenile myoclonic epilepsy

Abstract

Juvenile myoclonic epilepsy (JME) is the most common form of genetic generalized epilepsy. Patients with JME are at risk of life-threatening heart rhythm and conduction disorders as well as sudden death syndrome due to several potential mechanisms: genetic, clinical, neuroanatomical, pharmacological, psychological, comorbid. This lecture reviews important elements of knowledge about the pharmacological predictors of cerebral-cardiac syndrome and sudden unexpected death in epilepsy. The arrhythmogenic potential of antiepileptic drugs most often used in JME (valproic acid, levetiracetam, lamotrigine, topiramate and zonisamide) is considered, none of which can be classified as class A (drug without risk of QT interval prolongation or TdP) regarding a risk of QT interval prolongation and cardiac arrhythmias. Patients with JME require dynamic video-electroencephalographic monitoring and 24-hour electrocardiographic monitoring to reduce a risk of life-threatening cardiac arrhythmias.

Keywords

• cerebral-cardiac syndrome
• heart rhythm
• epilepsy
• juvenile myoclonic epilepsy
• sudden cardiac death
• sudden unexpected death in epilepsy
• antiepileptic drugs
• valproic acid
• levetiracetam
• lamotrigine
• topiramate
• zonisamide