Druschky A, Hilz M J, Hopp P, Platsch G, Radespiel-Tröger M, Druschky K, Kuwert T, Stefan H, Neundörfer B
Department of Neurology, University of Erlangen-Nuremberg, Germany.
Brain. 2001 Dec;124(Pt 12):2372-82. doi: 10.1093/brain/124.12.2372.
We studied the post-ganglionic cardiac sympathetic innervation in patients with chronic temporal lobe epilepsy (TLE) by means of [(123)I]metaiodobenzylguanidine-single photon computed tomography (MIBG-SPECT) and evaluated the effects of carbamazepine on cardiac sympathetic innervation. TLE is frequently associated with dysfunction of the autonomic nervous system. Autonomic dysregulation might contribute to unexplained sudden death in epilepsy. Anticonvulsive medication, particularly with carbamazepine, might also influence autonomic cardiovascular modulation. MIBG-SPECT allows the quantification of post-ganglionic cardiac sympathetic innervation, whereas measuring the variability of the heart rate provides only functional parameters of autonomic modulation. Antiepileptic drugs, especially carbamazepine (CBZ), can affect cardiovascular modulation. We determined the index of cardiac MIBG uptake (heart/mediastinum ratio) and heart rate variability (HRV) using time and frequency domain parameters of sympathetic and parasympathetic modulation in 12 women and 10 men (median age 34.5 years) with a history of TLE for 7-41 years (median 20 years). Myocardial perfusion scintigrams were examined to rule out deficiencies of MIBG uptake due to myocardial ischaemia. To assess the possible effects of CBZ on autonomic function, we compared MIBG uptake and HRV in 11 patients who had taken CBZ and 11 patients who had not taken CBZ, and in 16 healthy controls. In order to identify MIBG uptake defects due to myocardial ischaemia, all patients had a perfusion scintigram. Cardiac MIBG uptake was significantly less in the TLE patients (1.75) than in the controls (2.14; P = 0.001), but did not differ between subgroups with and without CBZ treatment. The perfusion scintigram was normal in all patients. Time domain analysis of HRV parameters suggested the predominance of parasympathetic cardiac activity in the TLE patients, but less parasympathetic modulation in the patients treated with CBZ than in those not treated with CBZ (P < 0.05), whereas frequency domain parameters showed no significant difference between the subgroups of patients or between patients and controls. MIBG-SPECT demonstrates altered post-ganglionic cardiac sympathetic innervation. This dysfunction might carry an increased risk of cardiac abnormalities.
我们通过[（123）I]间碘苄胍单光子计算机断层扫描（MIBG-SPECT）研究了慢性颞叶癫痫（TLE）患者的节后心脏交感神经支配情况，并评估了卡马西平对心脏交感神经支配的影响。TLE常与自主神经系统功能障碍相关。自主神经调节异常可能导致癫痫患者不明原因的猝死。抗惊厥药物，尤其是卡马西平，也可能影响自主心血管调节。MIBG-SPECT可对节后心脏交感神经支配进行量化，而测量心率变异性仅能提供自主调节的功能参数。抗癫痫药物，尤其是卡马西平（CBZ），可影响心血管调节。我们采用交感和副交感神经调节的时域和频域参数，测定了12名女性和10名男性（中位年龄34.5岁）TLE病史7至41年（中位20年）患者的心脏MIBG摄取指数（心脏/纵隔比值）和心率变异性（HRV）。检查心肌灌注闪烁图以排除因心肌缺血导致的MIBG摄取不足。为评估CBZ对自主神经功能的可能影响，我们比较了11名服用CBZ的患者、11名未服用CBZ的患者以及16名健康对照者的MIBG摄取和HRV。为识别因心肌缺血导致的MIBG摄取缺陷，所有患者均进行了灌注闪烁图检查。TLE患者的心脏MIBG摄取（1.75）显著低于对照组（2.14；P = 0.001），但在接受CBZ治疗和未接受CBZ治疗的亚组之间无差异。所有患者的灌注闪烁图均正常。HRV参数的时域分析表明，TLE患者以副交感神经心脏活动为主，但接受CBZ治疗的患者副交感神经调节作用低于未接受CBZ治疗的患者（P < 0.05），而频域参数显示患者亚组之间或患者与对照组之间无显著差异。MIBG-SPECT显示节后心脏交感神经支配改变。这种功能障碍可能会增加心脏异常的风险。
