Bruno Elisa, Biondi Andrea, Richardson Mark P
Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, UK.
Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, UK.
Seizure. 2018 Feb;55:48-56. doi: 10.1016/j.seizure.2018.01.003. Epub 2018 Jan 8.
To estimate the incidence of pre-ictal heart rate (HR) manifestations and to identify clinical and study-related factors modulating the estimate.
We searched articles recording concurrent pre-ictal EEG and HR in adults and children with epilepsy. Pre-ictal HR changes were classified as HR reduction (HRR) or increase (HRI). Studies reporting the total number of seizures and the number of seizures with pre-ictal HR changes were included in a random-effects meta-analysis. A random-effects meta-regression was used to identify variables affecting study heterogeneity.
Thirty studies, including 1110 participants and 2957 seizures, were included. The meta-analysis showed a pooled incidence of pre-ictal HRI of 36/100 seizures (95% CI 22-50). The pre-ictal HRI incidence was 44/100 seizures (95% CI 33-55) in studies including temporal lobe epilepsy, 55/100 seizures (95% CI 41-68) in studies enrolling adults and 35/100 seizures (95% CI 16-58) when patients on antiepileptic drugs were included. The meta-regression showed that the age group, the length of the pre-ictal period, the incidence of ictal tachycardia and the time of onset of the pre-ictal HRI had a significant impact on estimates variability. The pooled incidence of pre-ictal HRR was 0/100 seizures (95% CI 0-1).
Review of bias evaluation and methods assessment disclosed several major limitations in the evidence-base. HR monitoring could be valuable to identify seizures prior to their apparent onset, opening the possibility to early interventions. Additional effort is necessary to delineate the target population who might benefit from its use and the mechanisms sustaining the pre-ictal cardiac changes.
评估发作前心率（HR）表现的发生率，并确定影响该评估的临床及研究相关因素。
我们检索了记录癫痫成人和儿童发作前同步脑电图和心率的文章。发作前心率变化分为心率降低（HRR）或升高（HRI）。报告发作总数及发作前有心率变化的发作次数的研究纳入随机效应荟萃分析。采用随机效应元回归分析确定影响研究异质性的变量。
纳入30项研究，共1110名参与者和2957次发作。荟萃分析显示，发作前HRI的合并发生率为36/100次发作（95%CI 22 - 50）。在包括颞叶癫痫的研究中，发作前HRI发生率为44/100次发作（95%CI 33 - 55）；在纳入成人的研究中为55/100次发作（95%CI 41 - 68）；纳入服用抗癫痫药物患者的研究中为35/100次发作（95%CI 16 - 58）。元回归分析显示，年龄组、发作前期时长、发作时心动过速发生率以及发作前HRI的起始时间对评估变异性有显著影响。发作前HRR的合并发生率为0/100次发作（95%CI 0 - 1）。
对偏倚评估和方法评估的综述揭示了证据基础中的几个主要局限性。心率监测对于在发作明显开始前识别发作可能具有重要价值，为早期干预提供了可能性。需要进一步努力明确可能从其使用中获益的目标人群以及维持发作前心脏变化的机制。
