Hilz M J, Devinsky O, Doyle W, Mauerer A, Dütsch M
Department of Neurology, New York University, New York, NY, USA.
Brain. 2002 May;125(Pt 5):985-95. doi: 10.1093/brain/awf092.
In temporal lobe epilepsy (TLE), there is evidence of ictal and interictal autonomic dysregulation, predominantly with sympathetic overactivity. The effects of TLE surgery on autonomic cardiovascular control and on baroreflex sensitivity (BRS) have not been studied. To evaluate such effects, we monitored heart rate (HR), systolic blood pressure (BP(sys)) and respiration in 18 TLE patients 3-4 months before and after TLE surgery. We used Blackman-Tukey spectral analysis to assess sympathetic and parasympathetic modulation as powers of HR and BP(sys) oscillations in the low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.5 Hz) bands. BRS was determined as the LF transfer function gain between BP and HR. After surgery, HR, BP(sys), respiration and HF powers remained unchanged, while LF powers of HR (1.57 +/- 1.54 bpm(2)) and BP(sys) (2.19 +/- 1.34 mmHg(2)) and BRS (0.68 +/- 0.31 bpm/mmHg) were smaller than pre-surgical LF powers of HR (3.87 +/- 3.26 bpm(2)) and BP(sys) (4.80 +/- 3.84 mmHg(2)) and BRS (1.12 +/- 0.39 bpm/mmHg; P < 0.05). After TLE surgery, there is a reduction of sympathetic cardiovascular modulation and BRS that might result from decreased influences of interictal epileptogenic discharges on brain areas involved in cardiovascular autonomic control. TLE surgery seems to stabilize the cardiovascular control in epilepsy patients by reducing the risk of sympathetically mediated tachyarrhythmias and excessive bradycardiac counter-regulation, both of which might be relevant for the pathophysiology of sudden unexpected death in epilepsy patients (SUDEP). Thus, TLE surgery might contribute to reducing the risk of SUDEP.
在颞叶癫痫（TLE）中，有发作期和发作间期自主神经调节异常的证据，主要表现为交感神经过度活跃。尚未研究TLE手术对自主心血管控制和压力反射敏感性（BRS）的影响。为了评估这些影响，我们在18例TLE患者TLE手术前后3 - 4个月监测了心率（HR）、收缩压（BP(sys)）和呼吸。我们使用布莱克曼 - 图基谱分析来评估交感和副交感神经调制，以低频（LF，0.04 - 0.15Hz）和高频（HF，0.15 - 0.5Hz）频段的HR和BP(sys)振荡功率表示。BRS被确定为BP和HR之间的LF传递函数增益。手术后，HR、BP(sys)、呼吸和HF功率保持不变，而HR的LF功率（1.57±1.54 bpm²）、BP(sys)的LF功率（2.19±1.34 mmHg²）和BRS（0.68±0.31 bpm/mmHg）小于术前HR的LF功率（3.87±3.26 bpm²）、BP(sys)的LF功率（4.80±3.84 mmHg²）和BRS（1.12±0.39 bpm/mmHg；P < 0.05）。TLE手术后，交感心血管调制和BRS降低，这可能是由于发作间期致痫放电对参与心血管自主控制的脑区影响减少所致。TLE手术似乎通过降低交感神经介导的快速性心律失常和过度的心动过缓反调节风险来稳定癫痫患者的心血管控制，这两者都可能与癫痫患者突然意外死亡（SUDEP）的病理生理学相关。因此，TLE手术可能有助于降低SUDEP的风险。
