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: 29 February 2024 | Viewed by 2573

Special Issue Editors

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

Manuscript Submission Information

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Keywords

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

Published Papers (2 papers)

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Research

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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
J. Clin. Med. 2023, 12(13), 4284; https://doi.org/10.3390/jcm12134284 - 26 Jun 2023
Viewed by 1092
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
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Review

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13 pages, 6423 KiB  
Review
The Heart and Seizures: Friends or Enemies?
J. Clin. Med. 2023, 12(18), 5805; https://doi.org/10.3390/jcm12185805 - 06 Sep 2023
Cited by 1 | Viewed by 1176
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
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