Tatum William O, Acton Emily K, Langston Michael E, Yelvington Kirsten, Bowman Cammi, Shih Jerry J, Cheshire William P
Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA.
University of Pennsylvania, Philadelphia, PA, USA.
Seizure. 2016 Aug;40:15-20. doi: 10.1016/j.seizure.2016.05.012. Epub 2016 May 24.
To assess and compare peak, multimodal ictal vital signs (iVS) during epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES).
Between 4/1/2010 and 4/1/2011, 183 adults had video-EEG monitoring, with 96 consecutive patients meeting inclusion criteria. Heart rate (HR), oxygen saturation (SaO2), and blood pressure (BP) were obtained at baseline and during an ictus. The motor semiology of each ES and PNES was also assessed. Student t-test, Fischer's Test, Wilcoxon Test (p=<0.05), and linear regression provided statistical correlation.
The 46 patients with ES and 50 patients with PNES had similar baseline VS. Generalized tonic-clonic ES had the highest absolute iVS. ES yielded a higher absolute ictal HR (p=0.0004) and lower SaO2 nadir (p=0.003) than PNES. Systolic and diastolic BP did not differ between groups (p=NS). The upper ranges of iS-BP attained a maximum value of 195/135mm Hg in ES and 208/128mmHg in PNES. For ES, the change in ictal HR was inversely correlated with a reduction in ictal SaO2 (CC= -0.4; p=0.003). In PNES, ictal HR correlated with systolic BP (CC=0.6; p=<0.0001), but not ictal SaO2.
The inverse relationship between ictal HR and ictal SaO2 in ES suggests a neurobiological difference, and the concept of intrinsic cardio-respiratory dysfunction in patients with epilepsy. The significantly raised peak elevations in ictal HR and ictal systolic BP during PNES demonstrates the potential for serious adverse outcomes if attacks are prolonged.
评估并比较癫痫发作（ES）和精神性非癫痫发作（PNES）期间的峰值、多模式发作期生命体征（iVS）。
2010年4月1日至2011年4月1日期间，183名成年人接受了视频脑电图监测，其中96名连续患者符合纳入标准。在基线期和发作期获取心率（HR）、血氧饱和度（SaO2）和血压（BP）。还对每次ES和PNES的运动症状学进行了评估。采用学生t检验、费舍尔检验、威尔科克森检验（p<0.05）和线性回归进行统计相关性分析。
46例ES患者和50例PNES患者的基线生命体征相似。全面性强直阵挛性ES的绝对iVS最高。与PNES相比，ES的发作期绝对HR更高（p = 0.0004），最低SaO2更低（p = 0.003）。两组之间的收缩压和舒张压无差异（p =无显著性差异）。ES的发作期收缩压和舒张压最高值分别为195/135mmHg，PNES为208/128mmHg。对于ES，发作期HR的变化与发作期SaO2的降低呈负相关（CC = -0.4；p = 0.003）。在PNES中，发作期HR与收缩压相关（CC = 0.6；p<0.0001），但与发作期SaO2无关。
ES发作期HR与发作期SaO2之间的负相关关系提示了神经生物学差异，以及癫痫患者存在内在心肺功能障碍的概念。PNES发作期HR和发作期收缩压的显著升高表明，如果发作持续时间延长，可能会导致严重不良后果。
