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Quantitative Autonomic Testing
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Bitemporal seizure spread and its effect on autonomic dysfunction.

Thomas Page1, Fergus J Rugg-Gunn2

  • 1Dept. of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, United Kingdom.

Epilepsy & Behavior : E&B
|May 28, 2018
PubMed
Summary
This summary is machine-generated.

Bitemporal (both sides) temporal lobe epilepsy seizures significantly increase heart rate and reduce heart rate variability (HRV), suggesting a higher risk of sudden unexpected death in epilepsy (SUDEP).

Keywords:
Autonomic dysfunctionBitemporal seizureHeart rate variabilitySudden unexpected death in epilepsy

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Area of Science:

  • Neurology
  • Cardiology
  • Autonomic Neuroscience

Background:

  • Autonomic dysregulation is implicated in sudden unexpected death in epilepsy (SUDEP).
  • Temporal lobe epilepsy (TLE) seizures are frequently linked to cardiac arrhythmias and autonomic symptoms.
  • Understanding seizure propagation's impact on autonomic function is crucial for SUDEP risk assessment.

Purpose of the Study:

  • To compare the effects of unitemporal versus bitemporal TLE seizure activity on autonomic nervous system function.
  • To assess differences in heart rate variability (HRV) during unilateral and bilateral temporal lobe seizures.

Main Methods:

  • Retrospective analysis of electrocardiography (ECG) and intracranial electroencephalography (iEEG) data from 13 refractory TLE patients.
  • Evaluation of time, frequency, and nonlinear HRV parameters during baseline, preictal, postictal, unitemporal, and bitemporal ictal periods.
  • Analysis of 4-minute ECG epochs synchronized with iEEG seizure activity.

Main Results:

  • Heart rate was significantly elevated during bitemporal ictal activity compared to all other periods.
  • Time domain and nonlinear HRV parameters were significantly reduced during bitemporal activity versus baseline.
  • Key HRV components (SDNN, CV, RMSSD, SD1) were significantly lower during bitemporal compared to unitemporal seizures.
  • No significant differences were observed in frequency domain HRV parameters.

Conclusions:

  • Bitemporal TLE seizure activity leads to increased heart rate and diminished HRV.
  • This suggests a heightened autonomic imbalance, favoring sympathetic activity.
  • The findings indicate a potential increase in SUDEP risk associated with bilateral temporal lobe seizures.