Tran Thi Phuoc Yen, Pouliot Philippe, Assi Elie Bou, Rainville Pierre, Myers Kenneth A, Robert Manon, Bouthillier Alain, Keezer Mark R, Nguyen Dang Khoa
CHUM Research Center, University of Montreal, Montreal, QC H2X 0A9, Canada.
Safe Engineering Services and Technologies, Laval, QC H7L 6E8, Canada.
Brain Sci. 2021 Nov 13;11(11):1505. doi: 10.3390/brainsci11111505.
We aimed to evaluate heart rate variability (HRV) changes in insulo-opercular epilepsy (IOE) and after insulo-opercular surgery.
We analyzed 5-min resting HRV of IOE patients before and after surgery. Patients' SUDEP-7 risk inventory scores were also calculated. Results were compared with age- and sex-matched patients with temporal lobe epilepsy (TLE) and healthy individuals.
There were no differences in HRV measurements between IOE, TLE, and healthy control groups (and within each IOE group and TLE group) in preoperative and postoperative periods. In IOE patients, the SUDEP-7 score was positively correlated with pNN50 (percentage of successive RR intervals that differ by more than 50 ms) ( = 0.008) and RMSSD (root mean square of successive RR interval differences) ( = 0.019). We stratified IOE patients into those whose preoperative RMSSD values were below (Group 1a = 7) versus above (Group 1b = 9) a cut-off threshold of 31 ms (median value of a healthy population from a previous study). In group 1a, all HRV values significantly increased after surgery. In group 1b, time-domain parameters significantly decreased postoperatively.
Our results suggest that in IOE, HRV may be either decreased in parasympathetic tone or increased globally in both sympathetic and parasympathetic tones. We found no evidence that insulo-opercular surgeries lead to major autonomic dysfunction when a good seizure outcome is reached. The increase in parasympathetic tone observed preoperatively may be of clinical concern, as it was positively correlated with the SUDEP-7 score.
我们旨在评估岛叶-眶额癫痫（IOE）及岛叶-眶额手术后心率变异性（HRV）的变化。
我们分析了IOE患者手术前后5分钟静息状态下的HRV。还计算了患者的癫痫性猝死-7风险量表得分。将结果与年龄和性别匹配的颞叶癫痫（TLE）患者及健康个体进行比较。
在术前和术后阶段，IOE组、TLE组和健康对照组之间（以及每个IOE组和TLE组内部）的HRV测量值没有差异。在IOE患者中，癫痫性猝死-7得分与pNN50（连续RR间期差值大于50毫秒的百分比）（=0.008）和RMSSD（连续RR间期差值的均方根）（=0.019）呈正相关。我们将IOE患者分为术前RMSSD值低于（第1a组=7例）与高于（第1b组=9例）31毫秒临界值（先前研究中健康人群的中位数）的两组。在第1a组中，术后所有HRV值均显著增加。在第1b组中，时域参数术后显著降低。
我们的结果表明，在IOE中，HRV可能是副交感神经张力降低，或者交感神经和副交感神经张力均整体升高。我们没有发现证据表明，当癫痫发作结果良好时，岛叶-眶额手术会导致严重的自主神经功能障碍。术前观察到的副交感神经张力增加可能具有临床意义，因为它与癫痫性猝死-7得分呈正相关。
