Tomson T, Ericson M, Ihrman C, Lindblad L E
Department of Clinical Neuroscience, Karolinska Hospital, Stockholm, Sweden.
Epilepsy Res. 1998 Mar;30(1):77-83. doi: 10.1016/s0920-1211(97)00094-6.
Autonomic function was studied by the use of spectral analysis of heart-rate variability in patients with epilepsy in relation to type of epilepsy and anti-epileptic drug therapy. A total of 21 patients with juvenile myoclonic epilepsy (JME) and 21 with temporal lobe epilepsy (TLE) were included; 18 patients were treated with carbamazepine (CBZ), 16 with valproate (VPA) and seven with phenytoin (PHT). One healthy drug free control, matched for age and sex, was selected for each patient. Patients and controls underwent an ambulatory 24 h EKG. Heart-rate variability was analyzed in time and frequency domains. Patients with TLE had significantly lower S.D. of the RR-intervals, lower low frequency power and a lower low frequency/high frequency power ratio than their controls. A lower low frequency/high frequency power ratio was the only significant difference between the JME patient group and their controls. Treatment, however, may have had a considerable influence on the heart rate variability in the epilepsy patients. Patients on CBZ had significantly lower S.D. of RR-intervals, low frequency power and a low frequency/ high frequency power ratio than did their matched healthy drug free controls. The ratio of low frequency/high frequency power was also lower in patients on VPA compared with their controls, but apart from that no differences could be demonstrated between this treatment group and the controls. In conclusion, patients with epilepsy appear to have an altered autonomic control of the heart, with a reduction in some heart-rate variability measures, suggesting a decreased sympathetic tone, which may be related to the drug therapy or the epilepsy as such. Further studies are warranted to explore these changes and their possible relevance for sudden death in epilepsy.
通过心率变异性频谱分析研究癫痫患者的自主神经功能，探讨其与癫痫类型及抗癫痫药物治疗的关系。纳入21例青少年肌阵挛性癫痫（JME）患者和21例颞叶癫痫（TLE）患者；18例患者接受卡马西平（CBZ）治疗，16例接受丙戊酸盐（VPA）治疗，7例接受苯妥英（PHT）治疗。为每位患者选取一名年龄和性别匹配的健康未用药对照者。患者和对照者均进行24小时动态心电图监测。对心率变异性进行时域和频域分析。与对照者相比，TLE患者的RR间期标准差显著降低，低频功率降低，低频/高频功率比降低。低频/高频功率比降低是JME患者组与其对照者之间唯一的显著差异。然而，治疗可能对癫痫患者的心率变异性有相当大的影响。服用CBZ的患者RR间期标准差、低频功率和低频/高频功率比均显著低于与其匹配的健康未用药对照者。服用VPA的患者低频/高频功率比也低于其对照者，但除此之外，该治疗组与对照者之间未发现其他差异。总之，癫痫患者似乎存在心脏自主神经控制改变，一些心率变异性指标降低，提示交感神经张力降低，这可能与药物治疗或癫痫本身有关。有必要进一步研究这些变化及其与癫痫猝死的可能相关性。
