Department of Clinical Neurophysiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, United Kingdom.
Seizure. 2012 Jun;21(5):391-8. doi: 10.1016/j.seizure.2012.03.011. Epub 2012 Apr 10.
Autonomic instability is considered a contributing factor in sudden unexpected death in epilepsy (SUDEP). The aim of this pilot study was to measure parasympathetic activity in sub-clinical seizures to investigate autonomic instability.
A prospective study based on Video-electroencephalography (EEG)/electrocardiography (ECG)/oxygen saturation (SAO2) recordings was selected from patients having sub-clinical seizures during stage 3 or 4 sleep. We analysed R-R intervals in the ECG from 1-min prior to the electrographic onset to the end of sub-clinical seizures. Matched non-ictal R-R baseline measurements were selected from stages 3 or 4 sleep. R-R interval data were analysed using NeuroScope software providing a cardiac index of parasympathetic activity (CIPA). BioSignal short-term heart rate variability (HRV) software was used to analyse the same R-R interval data previously analysed using NeuroScope except that sub-clinical seizure data was embedded within 5-min epochs and compared to 5-min epochs of non-ictal measurements.
A total of 33 sub-clinical seizures were recorded from 11 patients comprising 19 generalised sub-clinical seizures (2 patients), 9 right temporal lobe sub-clinical seizures (5 patients) and 5 left temporal lobe sub-clinical seizures (4 patients) were compared to matched non-ictal measurements. Parasympathetic activity was clearly altered during total sub-clinical seizures in terms of the CIPA (p<0.001) and 5-min HRV high frequency (HF) % (p=0.026) measures. Generalised sub-clinical seizures resulted in increased cardiac parasympathetic activity whereas temporal lobe seizures were associated with a decrease in parasympathetic activity.
This pilot study indicates that parasympathetic changes occur during sub-clinical seizures. Generalised sub-clinical seizures may be associated with more autonomic instability compared to temporal lobe sub-clinical seizures.
自主神经不稳定被认为是癫痫猝死（SUDEP）的一个促成因素。本初步研究旨在通过测量亚临床发作中的副交感活性来研究自主神经不稳定。
选择了一项基于视频脑电图（EEG）/心电图（ECG）/血氧饱和度（SAO2）记录的前瞻性研究，该研究对象为在 3 期或 4 期睡眠中出现亚临床发作的患者。我们分析了 ECG 中从电发作前 1 分钟到亚临床发作结束的 R-R 间期。从 3 期或 4 期睡眠中选择匹配的非癫痫发作 R-R 基线测量值。使用 NeuroScope 软件分析 R-R 间期数据，提供副交感活动的心脏指数（CIPA）。使用 BioSignal 短期心率变异性（HRV）软件分析相同的 R-R 间期数据，该软件除了将亚临床发作数据嵌入 5 分钟时段并与非癫痫发作测量的 5 分钟时段进行比较外，还使用该软件分析数据。
从 11 名患者中记录了 33 次亚临床发作，包括 2 名患者的 19 次全身性亚临床发作、5 名患者的 9 次右侧颞叶亚临床发作和 4 名患者的 5 次左侧颞叶亚临床发作，与匹配的非癫痫发作测量值进行了比较。在总亚临床发作期间，CIPA（p<0.001）和 5 分钟 HRV 高频（HF）%（p=0.026）测量值明显改变了副交感活性。全身性亚临床发作导致心脏副交感活性增加，而颞叶发作则与副交感活性降低有关。
本初步研究表明，副交感神经在亚临床发作期间发生变化。与颞叶亚临床发作相比，全身性亚临床发作可能与更大的自主神经不稳定有关。
