Response to Letter by J Finsterer MD
Year: 2024
Type: article
Abstract: atherosclerosis Interictal periodTo the editor:We appreciate the thought-provoking comments by Dr. Finsterer [1] on our review of the medical literature that led us to propose the heuristic concept of the "Epileptic Heart Syndrome" [2].While Dr. Finsterer appears to acknowledge the potential involvement of increased cardiac risk in certain patients with chronic epilepsy, he questions the rationale and utility of our syndromic approach.The "Epileptic Heart Syndrome" classification is based on fundamental pathophysiology and a specific definition, namely, "a heart and coronary vasculature damaged by chronic epilepsy as a result of repeated surges in catecholamines and hypoxia leading to electrical and mechanical dysfunction."It is critical to recognize that the deleterious effects of seizures are not only acute but persist during the interictal period as evidenced by measures of cardiac electrical instability such as T-wave alternans [3].Other aspects of vascular disease also are evident in the interictal period, including carotid intima media thickening [4], stroke, transient ischemic attacks, and myocardial infarction [5], particularly in the older population.The criteria for diagnosis of the "Epileptic Heart Syndrome" are specified in detail in Table 2 of our review [2].These include, as foremost and essential, chronic epilepsy with or without drug resistance, as well as ECG evidence of myocardial injury, arrhythmia, and altered autonomic tone (heart rate variability measures); echocardiographic
Source: Epilepsy & Behavior Reports
Authors: Richard L. Verrier, Steven C. Schachter
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,310
OpenAlex ID: W4403670022