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Review
. 2021;28(2):330-335.
doi: 10.5603/CJ.a2019.0095. Epub 2019 Sep 30.

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

Patrycja J Szczurkowska  1 , Katarzyna Polonis  2 , Christiane Becari  3 , Michał Hoffmann  1 , Krzysztof Narkiewicz  1 , Marzena Chrostowska  4
Affiliations
Review

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

Patrycja J Szczurkowska et al. Cardiol J. 2021.

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.

Keywords: SUDEP; cardiovascular diseases; epilepsy; hypertension; neuroinflammation; renin–angiotensin system.

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Conflict of interest statement

Conflict of interest: None declared

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. doi: 10.1016/j.forsciint.2012.08.024. - DOI - PubMed
    1. Manolis TA, Manolis AA, Melita H, et al. Sudden unexpected death in epilepsy: The neuro-cardio-respiratory connection. Seizure. 2019;64:65–73. doi: 10.1016/j.seizure.2018.12.007. - DOI - PubMed
    1. 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. doi: 10.1042/CS20100053. - DOI - PubMed
    1. Shimada T, Takemiya T, Sugiura H, et al. Role of inflammatory mediators in the pathogenesis of epilepsy. Mediators Inflamm. 2014;2014 doi: 10.1155/2014/901902. 901902. - DOI - PMC - PubMed
    1. 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. doi: 10.1016/j.mcn.2015.02.014. - DOI - PubMed