Hilz M J, Dütsch M, Perrine K, Nelson P K, Rauhut U, Devinsky O
Department of Neurology, New York University, School of Medicine, NY 10016, USA.
Ann Neurol. 2001 May;49(5):575-84.
Several studies suggest hemispheric lateralization of autonomic cardiovascular control. There is controversy regarding which hemisphere dominates sympathetic or parasympathetic activity. Hemispheric influences on baroreflex sensitivity (BRS) have not yet been evaluated. To determine hemispheric autonomic control in epilepsy patients, we assessed cardiovascular and baroreflex modulation before and during hemispheric inactivation. For 15 patients with drug-refractory epilepsy, we analyzed autonomic heart rate (HR) and blood pressure (BP) modulation and BRS before and during left and right intracarotid amobarbital procedure (IAP). After Blackman-Tukey spectral analysis, we calculated the low-frequency (LF: 0.04-0.15 Hz) and high-frequency (HF: 0.15-0.5 Hz) power of HR and BP as well as BRS as the LF transfer function gain between BP and HR. Right hemispheric inactivation induced a significant decrease of BP and an increase of HF power of HR and BP (p < 0.05). Left inactivation increased HR, BP, and LF power of both signals and decreased BRS by nearly 30% (p < 0.05). The results confirm previous IAP studies showing sympathetic lateralization in the right hemisphere and, moreover, demonstrate parasympathetic predominance and up-regulation of BRS in the left hemisphere. In epilepsy patients, unilateral electrical activity might derange autonomic balance between both hemispheres and contribute to cardiovascular dysregulation and sudden fatalities.
多项研究表明自主心血管控制存在半球侧化现象。关于哪个半球主导交感神经或副交感神经活动存在争议。半球对压力反射敏感性（BRS）的影响尚未得到评估。为了确定癫痫患者的半球自主控制情况，我们在半球失活前后评估了心血管和压力反射调节。对于15例药物难治性癫痫患者，我们分析了在左右颈内动脉注射异戊巴比妥钠试验（IAP）前后的自主心率（HR）、血压（BP）调节及BRS。经过布莱克曼 - 图基谱分析后，我们计算了HR和BP的低频（LF：0.04 - 0.15Hz）和高频（HF：0.15 - 0.5Hz）功率以及作为BP与HR之间低频传递函数增益的BRS。右侧半球失活导致BP显著下降以及HR和BP的HF功率增加（p < 0.05）。左侧失活使HR、BP以及两个信号的LF功率增加，BRS降低近30%（p < 0.05）。结果证实了先前IAP研究显示的右侧半球交感神经侧化，此外，还证明了左侧半球副交感神经占优势以及BRS上调。在癫痫患者中，单侧电活动可能扰乱两个半球之间的自主平衡，并导致心血管调节异常和猝死。
