Utilizing multimodal imaging to visualize potential mechanism for sudden death in epilepsy.

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Abstrakt

Tytuł:: Utilizing multimodal imaging to visualize potential mechanism for sudden death in epilepsy.
Autorzy:: Mandal R; Weldon School of Biomedical Engineering, USA. Electronic address: .
Budde R; Weldon School of Biomedical Engineering, USA.
Lawlor GL; School of Electrical and Computer Engineering. Purdue University, West Lafayette, IN, USA.
Irazoqui P; Weldon School of Biomedical Engineering, USA; School of Electrical and Computer Engineering. Purdue University, West Lafayette, IN, USA.
Źródło:: Epilepsy & behavior : E&B [Epilepsy Behav] 2021 Sep; Vol. 122, pp. 108124. Date of Electronic Publication: 2021 Jul 05.
Typ publikacji:: Journal Article; Research Support, N.I.H., Extramural
Język:: English
Imprint Name(s):: Original Publication: San Diego, CA : Academic Press, c2000-
MeSH Terms:: Epilepsy*
Sudden Unexpected Death in Epilepsy*
Animals ; Death, Sudden/etiology ; Multimodal Imaging ; Rats ; Rats, Long-Evans
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Grant Information:: OT2 OD023847 United States OD NIH HHS
Contributed Indexing:: Keywords: Contrast enhanced MRI; Epilepsy; Gastroesophageal reflux; Laryngeal chemoreflex; Laryngospasm; MRI and electrophysiology; Multimodal imaging; SUDEP
Entry Date(s):: Date Created: 20210708 Date Completed: 20210914 Latest Revision: 20220902
Update Code:: 20240105
PubMed Central ID:: PMC8429091
DOI:: 10.1016/j.yebeh.2021.108124
PMID:: 34237676
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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 suggest critical contributions from autonomic, cardiac, and respiratory pathways. A potential mechanism for such sudden and severe cardiorespiratory dysregulation may be linked to acid reflux-induced laryngospasm. Here, we expand on our previous investigations and utilize a novel multimodal approach to provide visual evidence of acid reflux-initiated cardiorespiratory distress and subsequent sudden death 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 through a multimodal recording platform, during simultaneous fast MRI scans of the rat stomach and esophagus. MRI images, in correlation 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 larynx, which strongly suggested onset of laryngospasm following acid reflux. The complementary 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 it outlines a potential mechanism that may be relevant to SUDEP in humans.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2021 Elsevier Inc. All rights reserved.)

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