[Autonomic cardiovascular disorders in patients with epileptic and psychogenic non-epileptic seizures: a pilot study]

The purpose of our study was to investigate the hypothesis of greater severity of autonomic dysfunction in patients with concomitant epileptic and psychogenic non-epileptic seizures (PNES) (main group) compared to patients with exclusively epileptic seizures (comparison group) and healthy subjects (control group).

The main group included 13 subjects (median age 31 years [Q₁=21 years, Q₃=42 years], 9 females), and the control and comparison groups included 26 people each, comparable by sex and age to the main group. All patients underwent neurological and psychiatric examination, electroencephalography or video-electroencephalographic monitoring, and MRI. All patients had the following tests done: cardiointervalogramm, systolic blood pressure for each heartbeat, and tachogram for 5 minutes of lying down, active verticalization, and 5 minutes of orthostatic position. Heart rate variability in the time and frequency domains (lying) and blood pressure variability in the frequency domain (lying) were analyzed; also, the sensitivity of the arterial baroreflex and the 30:15 index were calculated. Pearson's Chi-square test, Kruskal-Wallis test, and post hoc Mann-Whitney U-test corrected for multiple Benjamini-Hochberg comparisons were used to compare the parameters.

In comparison with the control group, patients with epilepsy had autonomous regulation disorders as a total decrease in autonomous activity. However, in patients with epileptic seizures and PNES, more severe autonomic regulation disorders were observed, as indicated by a decrease in the 30:15 index and the arterial baroreflex sensitivity during an orthostatic test compared to patients without psychogenic seizures.

Patients with epilepsy showed a decrease in the autonomic regulation of the cardiovascular system. However, the concomitant PNES in patients with epilepsy was associated with a greater severity of autonomic dysfunction, in particular, during an orthostatic test.