Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal.
Epilepsy Behav. 2022 Jan;126:108453. doi: 10.1016/j.yebeh.2021.108453. Epub 2021 Dec 1.
Heart rate variability (HRV), an index of the autonomic cardiac activity, is decreased in patients with epilepsy, and a low HRV is associated with a higher risk of sudden death. Generalized tonic-clonic seizures are one of the most consistent risk factors for SUDEP, but the influence (and relative risk) of each type of seizure on cardiac function is still unknown. Our objective was to assess the impact of the type of seizure (focal to bilateral tonic-clonic seizure - FBTCS - versus non-FBTCS) on periictal HRV, in a group of patients with refractory epilepsy and both types of seizures.
We performed a 48-hour Holter recording on 121 patients consecutively admitted to our Epilepsy Monitoring Unit. We only included patients with both FBTCS and non-FBTCS on the Holter recording and selected the first seizure of each type to analyze. To evaluate HRV parameters (AVNN, SDNN, RMSSD, pNN20, LF, HF, and LF/HF), we chose 5-min epochs pre- and postictally.
We included 14 patients, with a median age of 36 (min-max, 16-55) years and 64% were female. Thirty-six percent had cardiovascular risk factors, but no previously known cardiac disease. In the preictal period, there were no statistically significant differences in HRV parameters, between FBTCS and non-FBTCS. In the postictal period, AVNN, RMSSD, pNN20, LF, and HF were significantly lower, and LF/HF and HR were significantly higher in FBTCS. From preictal to postictal periods, FBTCS elicited a statistically significant rise in HR and LF/HF, and a statistically significant fall in AVNN, RMSSD, pNN20, and HF. Non-FBTCS only caused statistically significant changes in HR (decrease) and AVNN (increase).
SIGNIFICANCE/CONCLUSION: This work emphasizes the greater effect of FBTCS in autonomic cardiac function in patients with refractory epilepsy, compared to other types of seizures, with a significant reduction in vagal tonus, which may be associated with an increased risk of SUDEP.
心率变异性（HRV）是自主心脏活动的指标，在癫痫患者中降低，并且低 HRV 与更高的猝死风险相关。全身性强直阵挛发作是 SUDEP 最一致的危险因素之一，但每种发作对心脏功能的影响（和相对风险）仍不清楚。我们的目的是评估发作类型（局灶性到双侧强直阵挛发作 - FBTCS - 与非 FBTCS）对难治性癫痫患者中发作间期 HRV 的影响，这些患者均存在这两种类型的发作。
我们对连续收入我们癫痫监测单元的 121 例患者进行了 48 小时动态心电图记录。我们仅包括在动态心电图记录中同时存在 FBTCS 和非 FBTCS 的患者，并选择每种类型的首次发作进行分析。为了评估 HRV 参数（AVNN、SDNN、RMSSD、pNN20、LF、HF 和 LF/HF），我们选择了发作前和发作后 5 分钟的时间窗。
我们纳入了 14 例患者，中位年龄为 36 岁（最小-最大，16-55 岁），64%为女性。36%有心血管危险因素，但无已知的心脏疾病。在发作前期间，FBTCS 和非 FBTCS 之间的 HRV 参数没有统计学上的显著差异。在发作后期间，AVNN、RMSSD、pNN20、LF 和 HF 显著降低，而 LF/HF 和 HR 显著升高。从发作前到发作后期间，FBTCS 引起 HR 和 LF/HF 的统计学显著升高，AVNN、RMSSD、pNN20 和 HF 的统计学显著降低。非 FBTCS 仅引起 HR（降低）和 AVNN（升高）的统计学显著变化。
意义/结论：这项工作强调了 FBTCS 在难治性癫痫患者自主心脏功能中的更大影响，与其他类型的发作相比，迷走神经张力显著降低，这可能与 SUDEP 的风险增加相关。
