Chen Wei, Guo Chang-Li, Zhang Pei-Song, Liu Chong, Qiao Hui, Zhang Jian-Guo, Meng Fan-Gang
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China.
BMC Neurol. 2014 Jun 20;14:135. doi: 10.1186/1471-2377-14-135.
We analyzed the frequency of heart rate (HR) changes related to seizures, and we sought to identify the influencing factors of these changes during partial seizures, to summarize the regularity of the HR changes and gain some insight into the mechanisms involved in the neuronal regulation of cardiovascular function. To date, detailed information on influencing factors of HR changes related to seizures by multiple linear regression analysis remains scarce.
Using video-electroencephalograph (EEG)-electrocardiograph (ECG) recordings, we retrospectively assessed the changes in the HR of 81 patients during a total of 181 seizures, including 27 simple partial seizures (SPS), 110 complex partial seizures (CPS) and 44 complex partial seizures secondarily generalized (CPS-G). The epileptogenic focus and the seizure type, age, gender, and sleep/wakefulness state of each patient were evaluated during and after the seizure onset. The HR changes were evaluated in the stage of epilepsy as time varies.
Of the 181 seizures from 81 patients with ictal ECGs, 152 seizures (83.98%) from 74 patients were accompanied by ictal tachycardia (IT). And only 1 patient was accompanied by ictal bradycardia (IB). A patient has both IT and IB. We observed that HR difference was independently correlated with side, type and sleep/wakefulness state. In this analysis, the HR changes were related to the side, gender, seizure type, and sleep/wakefulness state. Right focus, male, sleep, and CPS-G showed more significant increases than that were observed in left, female, wakefulness, SPS and CPS. HR increases rapidly within 10 seconds before seizure onset and ictus, and typically slows to normal with seizure offset.
CPS-G, sleep and right focus led to higher ictal HR. The HR in the stage of epilepsy has regularly been observed to change to become time-varying. The risk factors of ictal HR need to be controlled along with sleep, CPS-G and right focus. Our study first explains that the HR in seizures has a regular evolution varying with time. Our study might help to further clarify the basic mechanisms of interactions between heart and brain, making seizure detection and closed-loop systems a possible therapeutic alternative in refractory patients.
我们分析了与癫痫发作相关的心率（HR）变化频率，并试图确定部分性癫痫发作期间这些变化的影响因素，总结HR变化规律，深入了解心血管功能神经调节机制。迄今为止，通过多元线性回归分析获得的与癫痫发作相关的HR变化影响因素的详细信息仍然匮乏。
利用视频脑电图（EEG）-心电图（ECG）记录，我们回顾性评估了81例患者在总共181次癫痫发作期间的HR变化，包括27次简单部分性发作（SPS）、110次复杂部分性发作（CPS）和44次继发全身性发作的复杂部分性发作（CPS-G）。在癫痫发作开始期间及之后评估每位患者的致痫灶、癫痫发作类型、年龄、性别以及睡眠/清醒状态。随着时间变化，在癫痫发作阶段评估HR变化。
在81例有发作期心电图的患者的181次癫痫发作中，74例患者的152次发作（83.98%）伴有发作期心动过速（IT）。仅有1例患者伴有发作期心动过缓（IB）。有1例患者同时出现IT和IB。我们观察到HR差异与病灶侧别、类型以及睡眠/清醒状态独立相关。在此分析中，HR变化与病灶侧别、性别、癫痫发作类型以及睡眠/清醒状态有关。右侧病灶、男性、睡眠以及CPS-G比左侧病灶、女性、清醒状态、SPS和CPS表现出更显著的HR升高。HR在癫痫发作开始前10秒和发作期迅速升高，通常在发作结束时恢复正常。
CPS-G、睡眠和右侧病灶导致更高的发作期HR。癫痫发作阶段的HR有规律地随时间变化。发作期HR的危险因素需要与睡眠、CPS-G和右侧病灶一起控制。我们的研究首次解释了癫痫发作时HR随时间有规律地演变。我们的研究可能有助于进一步阐明心脏与大脑之间相互作用的基本机制，使癫痫发作检测和闭环系统成为难治性患者可能的治疗选择。
