Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
Neurology. 2010 Feb 2;74(5):421-6. doi: 10.1212/WNL.0b013e3181ccc706.
Generalized tonic-clonic seizures (GTCS) are a major risk factor for sudden unexpected death in epilepsy (SUDEP). We investigated whether ictal/postictal cardiac features were dependent on seizure type within individual patients.
ECG data from patients with medically refractory temporal lobe epilepsy (TLE) undergoing presurgical investigation who had both complex partial seizures and secondarily GTCS during video-EEG telemetry were retrospectively reviewed. Peri-ictal heart rate (HR), corrected QT interval (QTc), HR variability, and cardiac rhythm were assessed.
Twenty-five patients were included in this study. Secondarily GTCS led to higher ictal HR, persistent postictal tachycardia, and decreased postictal HR variability. Moreover, abnormal shortening of QTc occurred in 17 patients mainly during the early postictal phase and significantly more often in secondarily GTCS. Abnormal QTc prolongation occurred in 3 patients with no significant association with GTCS. Benign cardiac arrhythmias occurred in 14 patients and were independent of seizure type.
Our data suggest a substantial disturbance of autonomic function following secondarily generalized tonic-clonic seizures (GTCS) in patients with medically refractory temporal lobe epilepsy. The observed alterations could potentially facilitate sudden cardiac death and might contribute to the association of sudden unexpected death in epilepsy with GTCS.
全身性强直-阵挛性发作（GTCS）是癫痫猝死（SUDEP）的一个主要危险因素。我们研究了在个体患者中，发作期和发作后的心电特征是否取决于发作类型。
对接受术前评估的药物难治性颞叶癫痫（TLE）患者的心电图数据进行回顾性分析，这些患者在视频-脑电图遥测期间既有复杂部分性发作又有继发性 GTCS。评估了发作期心率（HR）、校正 QT 间期（QTc）、心率变异性和心律失常。
本研究共纳入 25 例患者。继发性 GTCS 导致更高的发作期 HR、持续的发作后心动过速和发作后 HR 变异性降低。此外，17 例患者在早期发作后出现 QTc 异常缩短，主要发生在继发性 GTCS 中，显著多于 GTCS。3 例患者出现 QTc 延长异常，但与 GTCS 无明显相关性。14 例患者出现良性心律失常，与发作类型无关。
我们的数据表明，药物难治性颞叶癫痫患者继发性全身性强直-阵挛性发作后自主神经功能受到严重干扰。观察到的改变可能会促进心脏性猝死，并可能导致癫痫猝死与 GTCS 的关联。
