Esmaeili Behnaz, Weisholtz Daniel, Tobochnik Steven, Dworetzky Barbara, Friedman Daniel, Kaffashi Farhad, Cash Sydney, Cha Brannon, Laze Juliana, Reich Dustine, Farooque Pue, Gholipour Taha, Singleton Michael, Loparo Kenneth, Koubeissi Mohamad, Devinsky Orrin, Lee Jong Woo
Department of Neurology, University of Washington, Seattle, WA, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Clin Neurophysiol. 2023 Feb;146:109-117. doi: 10.1016/j.clinph.2022.12.002. Epub 2022 Dec 16.
The association between postictal electroencephalogram (EEG) suppression (PES), autonomic dysfunction, and Sudden Unexpected Death in Epilepsy (SUDEP) remains poorly understood. We compared PES on simultaneous intracranial and scalp-EEG and evaluated the association of PES with postictal heart rate variability (HRV) and SUDEP outcome.
Convulsive seizures were analyzed in patients with drug-resistant epilepsy at 5 centers. Intracranial PES was quantified using the Hilbert transform. HRV was quantified using root mean square of successive differences of interbeat intervals, low-frequency to high-frequency power ratio, and RR-intervals.
There were 64 seizures from 63 patients without SUDEP and 11 seizures from 6 SUDEP patients. PES occurred in 99% and 87% of seizures on intracranial-EEG and scalp-EEG, respectively. Mean PES duration in intracranial and scalp-EEG was similar. Intracranial PES was regional (<90% of channels) in 46% of seizures; scalp PES was generalized in all seizures. Generalized PES showed greater decrease in postictal parasympathetic activity than regional PES. PES duration and extent were similar between patients with and without SUDEP.
Regional intracranial PES can be present despite scalp-EEG demonstrating generalized or no PES. Postictal autonomic dysfunction correlates with the extent of PES.
Intracranial-EEG demonstrates changes in autonomic regulatory networks not seen on scalp-EEG.
癫痫发作后脑电图抑制（PES）、自主神经功能障碍与癫痫性猝死（SUDEP）之间的关联仍未得到充分理解。我们比较了同步颅内脑电图和头皮脑电图上的PES，并评估了PES与发作后心率变异性（HRV）及SUDEP结局之间的关联。
对5个中心的耐药性癫痫患者的惊厥性发作进行分析。使用希尔伯特变换对颅内PES进行量化。使用心搏间期连续差值的均方根、低频与高频功率比以及RR间期对HRV进行量化。
63例无SUDEP患者发生了64次发作，6例SUDEP患者发生了11次发作。颅内脑电图和头皮脑电图上分别有99%和87%的发作出现了PES。颅内脑电图和头皮脑电图上的平均PES持续时间相似。46%的发作中颅内PES是局部性的（<90%的通道）；所有发作中头皮PES都是全身性的。全身性PES比局部性PES在发作后副交感神经活动方面有更大程度的降低。有和没有SUDEP的患者之间，PES的持续时间和范围相似。
尽管头皮脑电图显示为全身性或无PES，但仍可能存在局部性颅内PES。发作后自主神经功能障碍与PES的程度相关。
颅内脑电图显示出头皮脑电图上未观察到的自主神经调节网络变化。
