Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA.
Epilepsy Behav. 2013 Oct;29(1):240-6. doi: 10.1016/j.yebeh.2013.07.021. Epub 2013 Aug 27.
Interictal electrocardiographic predictors of sudden unexpected death in epilepsy (SUDEP) are unknown. This study was designed to identify the unique features of the interictal 12-lead electrocardiogram (EKG) in patients with epileptic seizures. We conducted a retrospective chart review of adult patients below the age of 65 admitted to our epilepsy monitoring unit. Using EEG telemetry data, we classified patients as having nonepileptic seizures (NESs), probable epilepsy (PE), or definite epilepsy (DE) and analyzed 12-lead EKGs obtained on admission. Patients with NESs were assigned as the control group. We included patients taking antipsychotic and/or antidepressant medications but excluded patients with medical conditions or taking other medications that would otherwise confound EKG measurements. Out of the 1007 charts reviewed, 195 patients were included in our analysis, and extensive subgroup analyses were performed. We found that patients with definite localization-related epilepsy displayed a significantly longer average PR interval (162.1 ms) than patients with NESs (148.8 ms). This effect was pronounced in female patients and did not vary with the number of antiepileptic drugs (AEDs) prescribed. In contrast to previous studies, mean QTc intervals were not significantly different between DE (428 ms) and NESs (422.6 ms). However, within females, this difference reached statistical significance (DE: 434.6 ms, NESs: 424.6 ms). Antiepileptic drug polytherapy was associated with a significantly lower QTc interval (416 ms in patients on 4-6 drugs and 436.4 ms in patients on 0-1 drugs). Levetiracetam was the most commonly used AED and was associated with the longest average PR (163 ms) and QTc (432 ms) intervals. The mean QRS axis displayed a significant leftward shift in patients with localization-related epilepsy (35.6° versus 54.3° in patients with NESs) and also in female patients with DE (42.1° versus 55.4° in female patients with NESs). No differences were observed between patients with left versus right hemisphere seizure foci. Overall, these findings may reflect cardiac structural changes and/or alterations in autonomic tone that deserve closer study. Further, longer-term prospective studies are required to understand how these electrocardiographic signatures may predict sudden unexpected death in epilepsy.
目前尚不清楚癫痫发作患者（癫痫）发生意外猝死（SUDEP）的间歇性心电图预测因素。本研究旨在确定癫痫发作患者间歇性 12 导联心电图（EKG）的独特特征。我们对我院癫痫监测单元收治的年龄在 65 岁以下的成年患者进行了回顾性图表审查。我们使用脑电图遥测数据将患者分为非癫痫性发作（NESs）、可能的癫痫（PE）或明确的癫痫（DE），并分析入院时获得的 12 导联 EKG。将 NES 患者分配为对照组。我们纳入了服用抗精神病药和/或抗抑郁药的患者，但排除了患有其他疾病或正在服用其他药物的患者，这些疾病或药物会干扰 EKG 测量。在审查的 1007 份图表中，有 195 名患者纳入我们的分析，并进行了广泛的亚组分析。我们发现，明确的局灶性相关癫痫患者的平均 PR 间隔（162.1ms）明显长于 NESs 患者（148.8ms）。这种影响在女性患者中更为明显，且与开处的抗癫痫药物（AED）数量无关。与之前的研究不同，DE（428ms）和 NESs（422.6ms）之间的平均 QTc 间隔无显著差异。然而，在女性中，这种差异具有统计学意义（DE：434.6ms，NESs：424.6ms）。抗癫痫药物联合治疗与 QTc 间隔显著降低相关（4-6 种药物治疗患者的 QTc 间隔为 416ms，0-1 种药物治疗患者的 QTc 间隔为 436.4ms）。左乙拉西坦是最常用的 AED，与最长的平均 PR（163ms）和 QTc（432ms）间隔相关。定位相关癫痫患者的 QRS 轴表现出明显的左移（与 NESs 患者的 35.6°相比），DE 女性患者也存在这种情况（与 NESs 女性患者的 55.4°相比）。在左半球或右半球痫灶患者之间未观察到差异。总体而言，这些发现可能反映了心脏结构的变化和/或自主神经张力的改变，值得进一步研究。此外，需要进行长期前瞻性研究，以了解这些心电图特征如何预测癫痫发作中的意外猝死。
