van der Kruijs Sylvie J M, Vonck Kristl E J, Langereis Geert R, Feijs Loe M G, Bodde Nynke M G, Lazeron Richard H C, Carrette Evelien, Boon Paul A J M, Backes Walter H, Jansen Jacobus F A, Aldenkamp Albert P, Cluitmans Pierre J M
Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands.
Reference Centre for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
Epilepsy Behav. 2016 Jan;54:14-9. doi: 10.1016/j.yebeh.2015.10.014. Epub 2015 Nov 25.
Psychogenic nonepileptic seizures (PNESs) resemble epileptic seizures but originate from psychogenic rather than organic causes. Patients with PNESs are often unable or unwilling to reflect on underlying emotions. To gain more insight into the internal states of patients during PNES episodes, this study explored the time course of heart rate variability (HRV) measures, which provide information about autonomic nervous system functioning and arousal.
Heart rate variability measures were extracted from double-lead electrocardiography data collected during 1-7days of video-electroencephalography monitoring of 20 patients with PNESs, in whom a total number of 118 PNESs was recorded. Heart rate (HR) and HRV measures in time and frequency domains (standard deviation of average beat-to-beat intervals (SDANN), root mean square of successive differences (RMSSD), high-frequency (HF) power, low-frequency (LF) power, and very low-frequency (VLF) power) were averaged over consecutive five-minute intervals. Additionally, quantitative analyses of Poincaré plot parameters (SD1, SD2, and SD1/SD2 ratio) were performed.
In the five-minute interval before PNES, HR significantly (p<0.05) increased (d=2.5), whereas SDANN (d=-0.03) and VLF power (d=-0.05) significantly decreased. During PNES, significant increases in HF power (d=0.0006), SD1 (d=0.031), and SD2 (d=0.016) were observed. In the five-minute interval immediately following PNES, SDANN (d=0.046) and VLF power (d=0.073) significantly increased, and HR (d=-5.1) and SD1/SD2 ratio (d=-0.14) decreased, compared to the interval preceding PNES.
The results suggest that PNES episodes are preceded by increased sympathetic functioning, which is followed by an increase in parasympathetic functioning during and after PNES. Future research needs to identify the exact nature of the increased arousal that precedes PNES.
心因性非癫痫性发作（PNES）类似于癫痫发作，但起源于心因性而非器质性原因。患有PNES的患者通常无法或不愿意反思潜在的情绪。为了更深入了解PNES发作期间患者的内部状态，本研究探讨了心率变异性（HRV）测量的时间进程，其提供了有关自主神经系统功能和唤醒的信息。
从20例PNES患者的视频脑电图监测1 - 7天期间收集的双导联心电图数据中提取心率变异性测量值，共记录到118次PNES发作。将心率（HR）以及时域和频域的HRV测量值（平均逐搏间期标准差（SDANN）、逐次差值均方根（RMSSD）、高频（HF）功率、低频（LF）功率和极低频（VLF）功率）在连续的五分钟间隔内进行平均。此外，还对庞加莱图参数（SD1、SD2和SD1/SD2比值）进行了定量分析。
在PNES发作前的五分钟间隔内，HR显著（p<0.05）升高（d = 2.5），而SDANN（d = -0.03）和VLF功率（d = -0.05）显著降低。在PNES发作期间，观察到HF功率（d = 0.0006）、SD1（d = 0.031）和SD2（d = 0.016）显著增加。与PNES发作前的间隔相比，在PNES发作后的立即五分钟间隔内，SDANN（d = 0.046）和VLF功率（d = 0.073）显著增加，而HR（d = -5.1）和SD1/SD2比值（d = -0.14）降低。
结果表明，PNES发作前交感神经功能增强，随后在PNES发作期间及发作后副交感神经功能增强。未来的研究需要确定PNES发作前唤醒增加的确切性质。
