Publication: Epilepsi hastalarında antiepileptik ilaçların otonom fonksiyon testleri ve QT dispersiyonuna etkisi
Abstract
Epilepsi hastalarında beklenmedik ani ölümler epilepsi olmayanlara göre yaklaşık 40 kat daha fazla gözlenmektedir. Bu durumun, otonom sinir sisteminin fonksiyon bozukluğu ile ilişkisi olduğu düşünülmektedir. Ancak bu ilişkinin epilepsinin kendisinden mi yoksa kullanılan ilaçlardan mı kaynaklandığı tam olarak açıklığa kavuşmamıştır. Bu çalışmanın amacı, epilepsi hastalarında, kardiyovasküler düzenleyici sistemin otonom fonksiyonunda bir bozukluk olup olmadığını ve antiepileptik kullanımının bu durumu nasıl etkilediğini araştırmaktır. Bu amaçla, daha önce antiepileptik ilaç kullanmamış, 17 epilepsi hastasında, antiepileptik ilaçlara başlamadan ve en az 6 aylık ilaç kullanımı sonrasında kardiyovasküler otonom fonksiyon testleri ile QT dispersiyonu (QTd) değerlendirilmiştir. Bulgular 17 sağlıklı erişkinin değerleri ile karşılaştırılmıştır. Hasta grubunun antiepileptik tedavi sonrasında, dinlenim durumundaki sistolik ve diastolik kan basınçları tedavi öncesine göre anlamlı olarak düşük saptanmıştır. Sistolik kan basıncındaki düşüş karbamazepin (KBZ); diyastolik kan basıncındaki düşüş, valproik asit (VPA) kullanımı ile ilişkili bulunmuştur. Tedavi öncesinde, jeneralize epilepsisi olan grupta valsalva oranı, parsiyel epilepsisi olan gruba göre daha yüksek bulunmuştur. Ayağa kalkmaya kalp hızı yanıtı olan 30/ 15 oranında tedavi öncesinde gruplar arası anlamlı bir fark gözlenmemiştir. Tedavi sonrasında, 30/ 15 oranı kontrol grubuyla karşılaştırıldığında daha yüksek tespit edildi. KBZ ya da VPA kullanımıyla kontrol grubuna ve tedavi öncesine göre 30/ 15 oranında anlamlı bir değişiklik saptanmadı. Soğuk testi ile kan basıncındaki artış değerlendirildiğinde gruplar arasında fark saptanmamıştır. Ancak soğuk testi ile KBZ kullanımıyla ilişkili olarak tedavi sonrasında dinlenim durumuna göre kalp hızında anlamlı bir artış gözlenmiştir. Tedavi öncesi ve sonrası QTd değerleri karşılaştırıldığında anlamlı bir fark gözlenmemiştir. Bu sonuçlar, hem epilepsinin kendisinin hem de antiepileptik kullanımının otonom sinir sistemi fonksiyonlarını etkilediğini düşündürmektedir. EFFECTS OF ANTIEPILEPTIC DRUGS ON AUTONOMIC FUNCTION TESTS AND QT DISPERSION IN EPILEPSY PATIENTS Adı ve Soyadı: Çiğdem Apaydın Kaya Danışman Adı: Prof.Dr. Filiz Onat Program: Farmakoloji ve Klinik Farmakoloji Farmakoloji ve Klinik Farmakoloji AD
Sudden unexplained death might occur 40 times more frequently among individuals with epilepsy than among those without epilepsy. This is thought to be related to a dysfunction of autonomic nervous system. However it has not yet been clarified whether it is related to the antiepileptic drugs. The aim of this study is to examine if there is an autonomic dysfunction in cardiovascular regulatory systems of epilepsy patients, and if such a disorder exists to find out its relation with the antiepileptic drugs. For this purpose, autonomic function tests and QT dispersion (QTd) are evaluated in newly diagnosed 17 epilepsy patients before and at least 6 months after antiepileptic drug therapy. Findings are compared with the control group consisting of 17 healthy subjects. In the patient group, measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) in resting state after therapy, were found significantly lower than before therapy. The decrease in the DBP was found related to valproic acid (VPA) administration while the decrease in SBP was related to carbamazepine (CBZ) administration. In the generalised epilepsy group, valsalva ratio was higher than observed partial epilepsy group before therapy. There was no difference between groups before and after therapy in the ratio 30/ 15, heart rate response to standing. However after therapy ratio was higher in the patient group compared to control group. CBZ administered patients and VPA administered patients did not show difference in 30/ 15 ratio before and after therapy. When blood pressure increase was evaluated with cold test, there was no difference between groups. With cold test, a significant increase compared to basal readings in heart rate after therapy was observed which was related with CBZ administration. No significant difference was observed when before therapy and after therapy QTd readings were compared. These results imply that epilepsy and antiepileptic drug therapy influence autonomic nervous system functions.
Sudden unexplained death might occur 40 times more frequently among individuals with epilepsy than among those without epilepsy. This is thought to be related to a dysfunction of autonomic nervous system. However it has not yet been clarified whether it is related to the antiepileptic drugs. The aim of this study is to examine if there is an autonomic dysfunction in cardiovascular regulatory systems of epilepsy patients, and if such a disorder exists to find out its relation with the antiepileptic drugs. For this purpose, autonomic function tests and QT dispersion (QTd) are evaluated in newly diagnosed 17 epilepsy patients before and at least 6 months after antiepileptic drug therapy. Findings are compared with the control group consisting of 17 healthy subjects. In the patient group, measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) in resting state after therapy, were found significantly lower than before therapy. The decrease in the DBP was found related to valproic acid (VPA) administration while the decrease in SBP was related to carbamazepine (CBZ) administration. In the generalised epilepsy group, valsalva ratio was higher than observed partial epilepsy group before therapy. There was no difference between groups before and after therapy in the ratio 30/ 15, heart rate response to standing. However after therapy ratio was higher in the patient group compared to control group. CBZ administered patients and VPA administered patients did not show difference in 30/ 15 ratio before and after therapy. When blood pressure increase was evaluated with cold test, there was no difference between groups. With cold test, a significant increase compared to basal readings in heart rate after therapy was observed which was related with CBZ administration. No significant difference was observed when before therapy and after therapy QTd readings were compared. These results imply that epilepsy and antiepileptic drug therapy influence autonomic nervous system functions.