Christophsbad Clinic, Göppingen 73035, Germany.
Ann Gen Psychiatry. 2013 Jun 13;12(1):19. doi: 10.1186/1744-859X-12-19.
This observational study documented heart rate over the entire course of electrically induced seizures and aimed to evaluate the effects of stimulus electrode placement, patients' age, stimulus dose, and additional predictors.
In 119 consecutive patients with 64 right unilateral (RUL) and 55 bifrontal (BF) electroconvulsive treatments, heart rate graphs based on beat-to-beat measurements were plotted up to durations of 130 s.
In RUL stimulation, the initial drop in heart rate lasted for 12.5 ± 2.6 s (mean ± standard deviation). This depended on stimulus train duration, age, and baseline heart rate. In seizures induced with BF electrode placement, a sympathetic response was observed within the first few seconds of the stimulation phase (median 3.5 s). This was also the case with subconvulsive stimulations. The mean peak heart rate in all 119 treatments amounted to 135 ± 20 bpm and depended on baseline heart rate and seizure duration; electrode placement, charge dose, and age were insignificant in regression analysis. A marked decline in heart rate in connection with seizure cessation occurred in 71% of treatments.
A significant independent effect of stimulus electrode positioning on cardiac action was evident only in the initial phase of the seizures. Electrical stimulation rather than the seizure causes the initial heart rate increase in BF treatments. The data reveal no rationale for setting the stimulus doses as a function of intraictal peak heart rates ('benchmark method'). The marked decline in heart rate at the end of most seizures is probably mediated by a baroreceptor reflex.
本观察性研究记录了电诱导癫痫发作过程中的心率，并旨在评估刺激电极放置、患者年龄、刺激剂量和其他预测因素的影响。
在 119 例连续患者中，进行了 64 例右侧单侧（RUL）和 55 例双额（BF）电惊厥治疗，根据逐拍测量绘制了长达 130 秒的心率图。
在 RUL 刺激中，心率的初始下降持续了 12.5±2.6 s（平均值±标准差）。这取决于刺激列车持续时间、年龄和基础心率。在 BF 电极放置诱导的癫痫发作中，在刺激阶段的最初几秒钟内观察到交感反应（中位数 3.5 s）。亚惊厥刺激也是如此。所有 119 种治疗的平均峰值心率为 135±20 bpm，取决于基础心率和癫痫持续时间；在回归分析中，电极放置、电荷量和年龄并不重要。在 71%的治疗中，与癫痫发作停止相关的心率显著下降。
刺激电极位置对心脏活动的显著独立影响仅在癫痫发作的初始阶段明显。电刺激而不是癫痫发作引起 BF 治疗中的初始心率增加。数据显示，没有理由将刺激剂量作为颅内峰值心率的函数（基准方法）。大多数癫痫发作结束时心率的显著下降可能是由压力感受器反射介导的。
