Au Yong Hue Mun, Minato Erica, Paul Eldho, Seneviratne Udaya
Department of Neuroscience, Monash Medical Centre, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
Department of Neuroscience, Monash Medical Centre, Melbourne, Australia.
Epilepsy Behav. 2020 Nov;112:107353. doi: 10.1016/j.yebeh.2020.107353. Epub 2020 Aug 27.
We aimed to (1) determine if seizure-related heart rate (HR) differentiates epileptic seizures (ES) from psychogenic nonepileptic seizures (PNES); (2) define the most useful point of the following HR measurements: preictal, ictal-onset, maximal-ictal, or postictal; and (3) delineate the optimal HR cutoff points (absolute HR and relative HR increase) to differentiate ES from PNES.
All video-electroencephalography (VEEG) recorded at an Australian tertiary hospital from May 2009 to November 2015 were retrospectively reviewed. Baseline (during rest and wakefulness), 1-min preictal, ictal-onset, maximal-ictal, and 1-min postictal HR were measured for each ES and PNES event. Events lasting <10 s or with uninterpretable electrocardiogram (ECG) due to artifacts were excluded. Receiver operating characteristic curve analysis was performed to assess the diagnostic accuracy of HR reflected by the area under the curve (AUC).
Video-electroencephalography of 341 ES and 265 PNES from 130 patients were analyzed. The AUC for preictal, ictal-onset, maximal-ictal, and postictal HR were found to have poor differentiation between all types of ES and PNES. However, comparing bilateral tonic-clonic ES and PNES, AUC for absolute maximal-ictal HR was 0.84 (95% confidence interval [CI]: 0.73-0.95) and for absolute postictal HR was 0.90 (95% CI: 0.81-1.00) indicating good diagnostic discrimination. Using Youden's index to diagnose tonic-clonic ES, the optimal cutoff point for absolute maximal-ictal HR was 114 bpm (sensitivity: 84%, specificity: 82%) and for absolute postictal HR was 90 bpm (sensitivity: 91%, specificity: 82%).
These findings suggest that seizure-related HR is useful in differentiating bilateral tonic-clonic ES from PNES. Based on the AUC, the best diagnostic measurements are maximal-ictal and postictal HR.
我们旨在（1）确定癫痫发作相关心率（HR）是否能区分癫痫发作（ES）和精神性非癫痫发作（PNES）；（2）确定以下HR测量中最有用的时间点：发作前、发作起始、发作高峰或发作后；（3）描绘区分ES和PNES的最佳HR截止点（绝对HR和相对HR增加）。
回顾性分析2009年5月至2015年11月在澳大利亚一家三级医院记录的所有视频脑电图（VEEG）。对每个ES和PNES事件测量基线（静息和清醒时）、发作前1分钟、发作起始、发作高峰和发作后1分钟的HR。持续时间<10秒或因伪迹导致心电图（ECG）无法解读的事件被排除。进行受试者操作特征曲线分析，以评估曲线下面积（AUC）反映的HR诊断准确性。
分析了130例患者的341次ES和265次PNES的视频脑电图。发现发作前、发作起始、发作高峰和发作后HR的AUC在所有类型的ES和PNES之间的区分能力较差。然而，比较双侧强直阵挛性ES和PNES，绝对发作高峰HR的AUC为0.84（95%置信区间[CI]：0.73 - 0.95），绝对发作后HR的AUC为0.90（95%CI：0.81 - 1.00），表明诊断区分良好。使用约登指数诊断强直阵挛性ES，绝对发作高峰HR的最佳截止点为114次/分钟（敏感性：84%，特异性：82%），绝对发作后HR的最佳截止点为90次/分钟（敏感性：91%，特异性：82%）。
这些发现表明，癫痫发作相关HR有助于区分双侧强直阵挛性ES和PNES。基于AUC，最佳诊断测量是发作高峰和发作后HR。
