Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Epilepsy Res. 2011 Aug;95(3):237-45. doi: 10.1016/j.eplepsyres.2011.04.005. Epub 2011 May 10.
Significant autonomic changes occur during seizures and may be related to sudden unexplained death in epilepsy (SUDEP). Accordingly, we performed a study to determine the prevalence of heart rate, QTc, and oximetric changes during seizures and analyzed their association with SUDEP risk factors. We analyzed 218 seizures from 76 patients. Ictal sinus tachycardia occurred in 57% of seizures and was associated with ≥3 failed AEDs (p=0.001), generalized seizures (p<0.001), and normal brain MRI (p=0.04). Ictal sinus bradycardia was rare, occurring in 2% of seizures. Ictal bradycardia was associated with seizure clustering (p=0.028) and reported history of ≥50 seizures/month (p=0.01). Depending on the correction formula utilized for calculating QTc, clinically significant ictal QTc prolongation (≥460ms for children ≤13 years, ≥470ms for males age >13, and ≥480ms for females age >13) occurred in 4.8-16.2% of seizures, while ictal QTc prolongation ≥500ms occurred in 2.9-16.2%. Ictal QTc shortening ≤340ms was observed in 3.8-4.8% of seizures. Ictal hypoxemia occurred in 25% of seizures and was associated with normal MRI (p=0.01), longer seizure duration (p=0.049), and ictal tachycardia (p=0.003). Such findings may have implications for understanding the pathogenesis of SUDEP.
在癫痫发作期间会发生显著的自主神经变化，并且可能与癫痫猝死（SUDEP）有关。因此，我们进行了一项研究，以确定癫痫发作期间心率、QTc 和血氧变化的发生率，并分析它们与 SUDEP 危险因素的关系。我们分析了 76 名患者的 218 次发作。57%的发作出现了发作性窦性心动过速，与≥3 种失败的抗癫痫药物（AEDs）（p=0.001）、全身性发作（p<0.001）和正常脑 MRI（p=0.04）相关。发作性窦性心动过缓很少见，仅发生于 2%的发作中。发作性心动过缓与发作群集（p=0.028）和每月报告≥50 次发作的病史（p=0.01）相关。根据计算 QTc 时使用的校正公式，4.8%-16.2%的发作中出现了临床显著的发作性 QTc 延长（≤13 岁的儿童为≥460ms，>13 岁的男性为≥470ms，>13 岁的女性为≥480ms），而发作性 QTc 延长≥500ms 发生在 2.9%-16.2%的发作中。3.8%-4.8%的发作中观察到了发作性 QTc 缩短≤340ms。25%的发作中出现了发作性低氧血症，与正常 MRI（p=0.01）、较长的发作持续时间（p=0.049）和发作性心动过速（p=0.003）相关。这些发现可能对理解 SUDEP 的发病机制有意义。
