scholarly journals Utilizing Multimodal Imaging to Visualize Potential Mechanism for Sudden Death in Epilepsy

2021 ◽  
Author(s):  
Ranajay Mandal ◽  
Ryan Budde ◽  
Georgia Louisa Lawlor ◽  
Pedro Irazoqui
Keyword(s):  
Sudden Death ◽  
Kainic Acid ◽  
Acid Reflux ◽  
Potential Mechanism ◽  
Fast Mri ◽  
St Segment Elevation ◽  
Stomach Acid ◽  
Esophageal Ph ◽  
Seizure Models ◽  
Mri Scans

Sudden death in epilepsy, or SUDEP, is a fatal condition that accounts for more than 4000 deaths each year. Limited clinical and preclinical data on sudden death suggests critical contributions from autonomic, cardiac, and respiratory pathways. Recent animal (rat) studies on kainic acid induced seizure models explored a potential mechanism for such sudden and severe cardiorespiratory dysregulation being linked to acid reflux induced laryngospasm. Here, we expand on those previous investigations and utilize a multimodal approach to provide visual evidence of acid reflux-initiated laryngospasm and subsequent fatal cardiorespiratory distress in seizing rats. We used systemic kainic acid to acutely induce seizure activity in Long Evans rats, under urethane anesthesia. We recorded electroencephalography (EEG), electrocardiography (ECG), chest plethysmography and esophageal pH signals during simultaneous fast MRI scans of the rat stomach and esophagus. MRI images, in conjunction with electrophysiology data were used to identify seizure progression, stomach acid movement up the esophagus, cardiorespiratory changes, and sudden death. In all cases of sudden death, esophageal pH recordings alongside MRI images visualized stomach acid movement up the esophagus. Severe cardiac (ST segment elevation), respiratory (intermittent apnea) and brain activity (EEG narrowing due to hypoxia) changes were observed only after acid reached the larynx, which strongly suggests onset of laryngospasm following acid reflux. Additionally, absence of stomach acid in the esophagus of animals that survived acute seizure, provided evidence of a causal relationship between acid reflux and sudden death. The complimentary information coming from electrophysiology and fast MRI scans provided insight into the mechanism of esophageal reflux, laryngospasm, obstructive apnea, and subsequent sudden death in seizing animals. The results carry clinical significance as they outline a potential mechanism that may be relevant to SUDEP in humans.

scholarly journals Acid reflux induced laryngospasm as a potential mechanism of sudden death in epilepsy

2018 ◽  
Vol 148 ◽  
pp. 23-31 ◽  
Author(s):  
Ryan B. Budde ◽  
Muhammad A. Arafat ◽  
Daniel J. Pederson ◽  
Thelma A. Lovick ◽  
John G.R. Jefferys ◽  
...  
Keyword(s):  
Sudden Death ◽  
Acid Reflux ◽  
Potential Mechanism

Eruptive Calcified Nodules as a Potential Mechanism of Acute Coronary Thrombosis and Sudden Death

2021 ◽  
Vol 77 (13) ◽  
pp. 1599-1611
Author(s):  
Sho Torii ◽  
Yu Sato ◽  
Fumiyuki Otsuka ◽  
Frank D. Kolodgie ◽  
Hiroyuki Jinnouchi ◽  
...  
Keyword(s):  
Sudden Death ◽  
Coronary Thrombosis ◽  
Potential Mechanism

scholarly journals Role of Provocable Brugada ECG Pattern in The Correct Risk Stratification for Major Arrhythmic Events

2021 ◽  
Vol 10 (5) ◽  
pp. 1025
Author(s):  
Nicolò Martini ◽  
Martina Testolina ◽  
Gian Luca Toffanin ◽  
Rocco Arancio ◽  
Luca De Mattia ◽  
...  
Keyword(s):  
Sudden Death ◽  
Risk Stratification ◽  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Conduction Delay ◽  
St Segment Elevation ◽  
Additional Information ◽  
The Right

The so-called Brugada syndrome (BS), first called precordial early repolarization syndrome (PERS), is characterized by the association of a fascinating electrocardiographic pattern, namely an aspect resembling right bundle branch block with a coved and sometime upsloping ST segment elevation in the precordial leads, and major ventricular arrhythmic events that could rarely lead to sudden death. Its electrogenesis has been related to a conduction delay mostly, but not only, located on the right ventricular outflow tract (RVOT), probably due to a progressive fibrosis of the conduction system. Many tests have been proposed to identify people at risk of sudden death and, among all, ajmaline challenge, thanks to its ability to enhance latent conduction defects, became so popular, even if its role is still controversial as it is neither specific nor sensitive enough to guide further invasive investigations and managements. Interestingly, a type 1 pattern has also been induced in many other cardiac diseases or systemic diseases with a cardiac involvement, such as long QT syndrome (LQTS), arrhythmogenic right ventricular cardiomyopathy (ARVC), hypertrophic cardiomyopathy (HCM) and myotonic dystrophy, without any clear arrhythmic risk profile. Evidence-based studies clearly showed that a positive ajmaline test does not provide any additional information on the risk stratification for major ventricular arrhythmic events on asymptomatic individuals with a non-diagnostic Brugada ECG pattern.

scholarly journals Right Bundle Branch Block, Right Precordial ST-Segment Elevation, and Sudden Death in Young People

Circulation ◽  
2001 ◽  
Vol 103 (5) ◽  
pp. 710-717 ◽  
Author(s):  
Domenico Corrado ◽  
Cristina Basso ◽  
Gianfranco Buja ◽  
Andrea Nava ◽  
Lino Rossi ◽  
...  
Keyword(s):  
Young People ◽  
Sudden Death ◽  
Right Bundle Branch Block ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
St Segment

scholarly journals SWALLOWING IN PATIENTS WITH LARYNGITIS

2018 ◽  
Vol 55 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Isabela MODA ◽  
Hilton Marcos Alves RICZ ◽  
Lilian Neto AGUIAR-RICZ ◽  
Roberto Oliveira DANTAS
Keyword(s):  
Transit Time ◽  
Random Sequence ◽  
Acid Reflux ◽  
Bolus Transit ◽  
Normal Volunteers ◽  
Esophageal Ph ◽  
Solid Bolus ◽  
Oral Preparation ◽  
Pharyngeal Transit ◽  
Liquid Bolus

ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

scholarly journals Modulation by colonic fermentation of LES function in humans

2000 ◽  
Vol 278 (4) ◽  
pp. G578-G584 ◽  
Author(s):  
Thierry Piche ◽  
Frank Zerbib ◽  
Stanislas Bruley Des Varannes ◽  
Christine Cherbut ◽  
Younès Anini ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Peptide Yy ◽  
Short Chain Fatty Acids ◽  
Acid Reflux ◽  
Colonic Fermentation ◽  
Standard Meal ◽  
Esophageal Ph ◽  
Baseline Recording ◽  
Esophageal Sphincter ◽  
Saline Solutions

Colonic fermentation of carbohydrate has been shown to influence gastric and intestinal motility. Our aim was to investigate the effects of colonic infusion of lactose and short-chain fatty acids (SCFAs) on lower esophageal sphincter (LES) function in humans. LES pressure (LESP), transient relaxations of LES (TLESRs), and esophageal pH were monitored over 6 h on 4 different days in 7 healthy volunteers. After 1 h of baseline recording, the effects of different colonic infusions (270 ml of isotonic or hypertonic saline, 30 g lactose, or 135 mmol SCFAs) were tested in fasting conditions and after a standard meal. Peptide YY (PYY) and oxyntomodulin (OLI) were also measured in plasma. Both lactose and SCFA infusions increased the number of TLESRs as well as the proportion of TLESRs associated with acid reflux episodes, but saline solutions did not. The postprandial fall of LESP was enhanced by previous SCFA infusion. Plasma PYY and OLI increased similarly after all colonic infusions. Colonic fermentation of lactose markedly affected LES function, and this effect was reproduced by SCFA infusion. Whether the mechanisms of this feedback phenomenon are of hormonal nature, neural nature, or both remains to be determined.

Sign in / Sign up

Export Citation Format

Share Document