Flasbeck Vera, Jungilligens Johannes, Lemke Isabell, Beckers Jule, Öztürk Hilal, Wellmer Jörg, Seliger Corinna, Juckel Georg, Popkirov Stoyan
Division of Clinical and Experimental Neurophysiology, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University, LWL University Hospital, Bochum, Germany.
Department of Neurology, Ruhr University, University Hospital Knappschaftskrankenhaus, Bochum, Germany.
BMJ Neurol Open. 2024 Jun 5;6(1):e000665. doi: 10.1136/bmjno-2024-000665. eCollection 2024.
Dissociative seizures often occur in the context of dysregulated affective arousal and entail dissociative symptoms such as a disintegration of bodily awareness. However, the interplay between affective arousal and changes in interoceptive processing at the onset of dissociative seizures is not well understood.
Using retrospective routine data obtained from video-electroencephalography telemetry in a university hospital epilepsy monitoring unit, we investigate ictal changes in cardiac indices of autonomic arousal and heartbeat evoked potentials (HEPs) in 24 patients with dissociative seizures.
Results show autonomic arousal during seizures with increased heart rate and a shift towards sympathetic activity. Compared with baseline, ictal HEP amplitudes over central and right prefrontal electrodes (F8, Fz) were significantly less pronounced during seizures, suggesting diminished cortical representation of interoceptive information. Significant correlations between heart rate variability measures and HEPs were observed at baseline, with more sympathetic and less parasympathetic activity related to less pronounced HEPs. Interestingly, these relationships weakened during seizures, suggesting a disintegration of autonomic arousal and interoceptive processing during dissociative seizures. In a subgroup of 16 patients, MRI-based cortical thickness analysis found a correlation with HEP amplitudes in the left somatosensory association cortex.
These findings possibly represent an electrophysiological hint of how autonomic arousal could negatively impact bodily awareness in dissociative seizures, and how these processes might be related to underlying brain structure.
分离性癫痫发作常发生于情感唤醒失调的背景下，并伴有诸如身体意识解体等分离性症状。然而，分离性癫痫发作起始时情感唤醒与内感受性加工变化之间的相互作用尚不清楚。
利用从大学医院癫痫监测单元的视频脑电图遥测获得的回顾性常规数据，我们调查了24例分离性癫痫发作患者自主唤醒的心脏指标和心跳诱发电位（HEP）的发作期变化。
结果显示癫痫发作期间自主唤醒，心率增加并向交感神经活动转变。与基线相比，癫痫发作期间中央和右前额叶电极（F8、Fz）上的发作期HEP振幅明显减弱，表明内感受性信息的皮层表征减少。在基线时观察到心率变异性测量与HEP之间存在显著相关性，交感神经活动越多、副交感神经活动越少与HEP越不明显相关。有趣的是，这些关系在癫痫发作期间减弱，表明分离性癫痫发作期间自主唤醒和内感受性加工解体。在16例患者的亚组中，基于MRI的皮层厚度分析发现与左体感联合皮层的HEP振幅存在相关性。
这些发现可能代表了自主唤醒如何对分离性癫痫发作中的身体意识产生负面影响，以及这些过程可能如何与潜在脑结构相关的电生理线索。
