Cardiovascular protective effect of melatonin in sudden unexpected death in epilepsy: a hypothesis.
Epilepsy is the most common neurological disorder, approximately 1% of the population worldwide have epilepsy. Moreover, sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Information concerning risk factors for SUDEP is conflicting, but potential risk factors include: age, early onset of epilepsy, duration of epilepsy, uncontrolled seizures, seizure frequency, AED number and winter temperatures. Additionally, the cause of SUDEP is still unknown; however, the most commonly suggested mechanisms are cardiac abnormalities during and between seizures. Furthermore, the evidence from the last 10 years suggests that melatonin has an important role in the epileptogenesis process and influences the cardiovascular system as well. The positive effect of melatonin has been demonstrated against different convulsive stimuli in several rodents, including seizures induced by pentylenetetrazole kainate, glutamate, maximal electrical shock and electrically kindled stimulation of amygdala. Clinical studies have also demonstrated a positive role of melatonin on the seizure frequency in children and reduced spiking activity and seizure frequency in patients with intractable epilepsy. In the rat hearts, studies in vivo and in vitro using pharmacological concentrations of melatonin confirmed an anti-arrhythmic effect of this hormone and studies in humans have been shown that chronic heart disease patients have significantly lower melatonin levels in their blood stream than do normal individuals. Thus, caution should be taken in generalization of these findings to epileptic population. Moreover, it is important to note that when dealing with intractable epilepsy that do not respond to any conventional treatment, the additional of melatonin may be evaluated. Taken together, in this paper we suggested a possible relationship between cardiac abnormalities, melatonin and SUDEP.
Scorza
Fulvio A
FA
Laboratory of Experimental Neurology, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil. scorza.nexp@epm.br
Colugnati
Diego B
DB
Arida
Ricardo M
RM
de Lima
Eliângela
E
Naffah-Mazzacoratti
Maria da Graça
Mda G
Cavalheiro
Esper A
EA
Amado
Débora
D
D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003645:Death, Sudden / Q000209:etiology / Q000517:prevention & control*; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008550:Melatonin / Q000627:therapeutic use*; D008954:Models, Biological; D012307:Risk Factors; D012640:Seizures / Q000517:prevention & control*
D002316:Cardiotonic Agents; D008550:Melatonin