Persson Håkan, Kumlien Eva, Ericson Mats, Tomson Torbjörn
Department of Clinical Neuroscience, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
Epilepsia. 2007 May;48(5):917-22. doi: 10.1111/j.1528-1167.2006.00961.x. Epub 2007 Feb 27.
Case-control studies of sudden unexpected death in epilepsy (SUDEP) have reported that SUDEP is more likely to occur during sleep and thus presumably during night hours. The circadian variation of heart-rate variability (HRV) might be of relevance to this risk. We examined night versus daytime HRV in patients with newly diagnosed and refractory localization-related epilepsy, assessing the effects of drug treatment and epilepsy surgery on the night/daytime HRV ratio.
We used spectral analysis to assess HRV and calculated the night-time (00.00-05.00)/daytime (07.30-21.30) ratio of HRV in 14 patients with newly diagnosed localization-related epilepsy before and during carbamazepine (CBZ) treatment and in 21 patients with temporal lobe epilepsy before and after epilepsy surgery. Both groups were compared with age- and sex-matched controls.
No significant differences were found from controls in the night/daytime ratios of HRV whether compared before or after initiation of treatment with CBZ in newly diagnosed epilepsy patients. When patients were used as their own controls, night/daytime ratios of standard deviation of RR intervals (p = 0.04) and total power (p = 0.04) were significantly lower during treatment than before. Compared with those of controls, the night/daytime ratios were lower in epilepsy surgery patients before surgery [low-frequency power (p = 0.04); high-frequency power (p = 0.04)]. Night/daytime ratios did not change significantly after surgery.
The HRV of the patients was more affected during night-time when the risk of SUDEP seems to be highest in such patients.
癫痫性猝死（SUDEP）的病例对照研究报告称，SUDEP更可能发生在睡眠期间，因此推测是在夜间。心率变异性（HRV）的昼夜变化可能与这种风险相关。我们研究了新诊断的难治性局灶性癫痫患者夜间与白天的HRV，评估药物治疗和癫痫手术对夜间/白天HRV比值的影响。
我们使用频谱分析评估HRV，并计算了14例新诊断的局灶性癫痫患者在卡马西平（CBZ）治疗前和治疗期间以及21例颞叶癫痫患者在癫痫手术前后HRV的夜间（00:00 - 05:00）/白天（07:30 - 21:30）比值。两组均与年龄和性别匹配的对照组进行比较。
新诊断癫痫患者在开始使用CBZ治疗前后，其HRV的夜间/白天比值与对照组相比均无显著差异。当以患者自身作为对照时，RR间期标准差（p = 0.04）和总功率（p = 0.04）的夜间/白天比值在治疗期间显著低于治疗前。与对照组相比，癫痫手术患者术前的夜间/白天比值较低[低频功率（p = 0.04）；高频功率（p = 0.04）]。术后夜间/白天比值无显著变化。
在SUDEP风险似乎最高的夜间，患者的HRV受影响更大。
