Szurhaj William, Troussière Anne-Cécile, Logier Régis, Derambure Philippe, Tyvaert Louise, Semah Franck, Ryvlin Philippe, De Jonckheere Julien
From the Epilepsy Unit (W.S., A.-C.T., P.D., L.T.), INSERM CIC-IT 1403 (R.L., J.D.J.), Department of Nuclear Medicine and Molecular Imaging (F.S.), Lille University Medical Center; INSERM U1171 (W.S., P.D., L.T., F.S.), University of Lille, France; and the Department of Clinical Neuroscience (P.R.), Lausanne, Switzerland.
Neurology. 2015 Oct 6;85(14):1233-9. doi: 10.1212/WNL.0000000000001994. Epub 2015 Sep 4.
To measure changes in parasympathetic tone before, during, and after temporal seizures, and to determine whether changes in high-frequency heart rate variability are correlated with postictal oxygen desaturation.
We recorded the electrocardiogram and peripheral oxygen saturation during 55 temporal lobe seizures and calculated a high-frequency variability index (HFVI) as a marker of parasympathetic tone for periods of 20 minutes (centered on seizure onset). We then compared HFVI values in seizures with and without postictal hypoxemia, and looked for correlations between HFVI changes and the risk of sudden unexpected death in epilepsy (SUDEP) (as assessed with the SUDEP-7 Inventory).
Parasympathetic tone decreased rapidly at the onset of temporal lobe seizures, reached its minimum value at the end of the seizure, and then gradually returned to its preictal value. Changes in parasympathetic tone were more intense and longer-lasting in older patients with a longer duration of epilepsy. The HFVI was significantly lower during seizures with hypoxemia, and remained significantly lower 5 minutes after the end of the seizure. The change in the HFVI slope over the first 30 seconds of the seizure was predictive of postictal oxygen desaturation. Postictal autonomic changes were correlated with the SUDEP-7 scores.
Our results showed that ictal autonomic dysfunction is correlated with postictal hypoxemia. A prolonged impairment of parasympathetic tone might expose a patient to a greater risk of postictal sudden unexpected death. The real-time measurement of parasympathetic tone in patients with epilepsy may be of value to medical staff as an early warning system.
测量颞叶癫痫发作前、发作期间及发作后的副交感神经张力变化，并确定高频心率变异性的变化是否与发作后氧饱和度下降相关。
我们记录了55例颞叶癫痫发作期间的心电图和外周血氧饱和度，并计算了高频变异性指数（HFVI），作为以癫痫发作开始为中心的20分钟时间段内副交感神经张力的标志物。然后，我们比较了有和没有发作后低氧血症的癫痫发作中的HFVI值，并寻找HFVI变化与癫痫猝死（SUDEP）风险之间的相关性（通过SUDEP-7量表评估）。
颞叶癫痫发作开始时副交感神经张力迅速下降，在发作结束时达到最小值，然后逐渐恢复到发作前的值。癫痫病程较长的老年患者副交感神经张力的变化更强烈且持续时间更长。低氧血症发作期间HFVI显著降低，发作结束后5分钟仍显著降低。癫痫发作前30秒内HFVI斜率的变化可预测发作后氧饱和度下降。发作后自主神经变化与SUDEP-7评分相关。
我们的结果表明，发作期自主神经功能障碍与发作后低氧血症相关。副交感神经张力长期受损可能使患者面临更高的发作后突然意外死亡风险。对癫痫患者副交感神经张力的实时测量作为一种早期预警系统，可能对医务人员有价值。
