Autonomic changes following generalized tonic clonic seizures: An analysis of adult and pediatric patients with epilepsy

Sarkis, Rani A.; Thomé‐Souza, Sigride; Poh, Ming‐Zher; Llewellyn, Nichelle; Klehm, Jacquelyn; Madsen, Joseph R.; Picard, Rosalind W.; Pennell, Page B.; Dworetzky, Barbara A.; Loddenkemper, Tobias; Reinsberger, Claus

doi:10.1016/j.eplepsyres.2015.06.005

Cited by 98 publications

(84 citation statements)

References 29 publications

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“…Both signals exhibit marked changes upon the onset of most CSs 22,23,34 . Both classifiers can operate within a nonstigmatizing wrist-worn device, the location preferred by most patients 35 , providing wearability for EMU and home use.…”

Section: Discussionmentioning

confidence: 99%

“…The measure of the autonomic impact of each seizure has previously been found to correlate with the duration of PGES after FTCb and GTC seizures 23,34 , which has been proposed as a biomarker for SUDEP 5 . While no device has been shown to reduce the risk of SUDEP, which would require very large studies, incorporating EDA analysis in a home seizure detector may help to identify, characterize and alert caregivers to potentially dangerous seizures.…”

Section: Seizure Characterizationmentioning

confidence: 99%

“…A "significant EDR" was identified when EDA increased more than twice the standard deviation of the pre-ictal baseline 23,34 . The EDR was considered ended when the EDA fell below 10%…”

Section: Seizure Characterization: Estimating Motion Duration and Posmentioning

confidence: 99%

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Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Onorati¹,

Regalia²,

Caborni³

et al. 2017

Epilepsia

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Running title: Wearable multimodal motor seizure detectors Onorati et al. 2 Summary Objective:New devices are needed for monitoring seizures, especially those associated with sudden unexpected death in epilepsy (SUDEP). They must be unobtrusive, automated and provide false alarm rates bearable in everyday life. This study quantifies the performance of new multimodal wrist-worn convulsive seizure detectors. Methods:Hand-annotated video-electroencephalography seizure events were collected from 69 patients at 6 clinical sites. Three different wristbands were used to record electrodermal activity (EDA) and accelerometer (ACM) signals, obtaining 5,928 hours of data, including 55 convulsive epileptic seizures (6 focal tonic-clonic seizures and 49 focal-to-bilateral-tonicclonic seizures) from 22 patients. Recordings were analyzed off-line to train and test two new machine learning classifiers and a published EDA and ACM-based classifier. Moreover, wristband data were analyzed to estimate seizure-motion duration and autonomic responses. Results:The two novel classifiers consistently outperformed the previous detector. The most efficient (Classifier III) yielded sensitivity of 94.55%, and false alarm rate (FAR) of 0.2 events/day.No nocturnal seizures were missed. Most patients had less than 1 false alarm every 4 days with FAR below their seizure frequency. When increasing the sensitivity to 100% (no missed seizures) the FAR is up to 13 times lower than the previous detector. Furthermore, all detections occurred before the seizure ended, providing reasonable latency (median: 29.3 s, range: 14.8-151 s). Automatically estimated seizure durations were correlated with true durations, enabling reliable annotations. Finally, EDA measurements confirmed the presence of post-ictal autonomic dysfunction, exhibiting a significant rise in 73% of the convulsive seizures. Onorati et al. 3 Significance:The proposed multimodal wrist-worn convulsive seizure detectors provide seizure counts that are more accurate than previous automated detectors and typical patient self-reports, while maintaining a tolerable FAR for ambulatory monitoring. Furthermore, the multimodal system provides an objective description of motor behaviour and autonomic dysfunction, aimed at enriching seizure characterization, with potential utility for SUDEP warning.

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Section: Discussionmentioning

confidence: 99%

Section: Seizure Characterizationmentioning

confidence: 99%

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Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Onorati¹,

Regalia²,

Caborni³

et al. 2017

Epilepsia

Self Cite

173

169

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“…For instance, studies on patients with Rolandic epilepsy have shown that vagal tone is enhanced compared with neurologically normal controls (Seri et al 2012), whereas other studies have shown evidence of sympathetic overdrive and parasympathetic depression (Behbahani et al 2016;Raju et al 2012). In light of these opposing findings, it has been suggested that a more systematic investigation of sympathoparasympathetic balance in the absence of seizures is necessary to develop current approaches to treating epilepsy and preventing SUDEP (Sarkis et al 2015).…”

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confidence: 99%

Decreased heart rate and enhanced sinus arrhythmia during interictal sleep demonstrate autonomic imbalance in generalized epilepsy

Sivakumar

Namath

Tuxhorn

et al. 2016

Journal of Neurophysiology

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Sivakumar SS, Namath AG, Tuxhorn IE, Lewis SJ, Galán RF. Decreased heart rate and enhanced sinus arrhythmia during interictal sleep demonstrate autonomic imbalance in generalized epilepsy. J Neurophysiol 115: 1988 -1999. First published February 17, 2016 doi:10.1152/jn.01120.2015.-We hypothesized that epilepsy affects the activity of the autonomic nervous system even in the absence of seizures, which should manifest as differences in heart rate variability (HRV) and cardiac cycle. To test this hypothesis, we investigated ECG traces of 91 children and adolescents with generalized epilepsy and 25 neurologically normal controls during 30 min of stage 2 sleep with interictal or normal EEG. Mean heart rate (HR) and high-frequency HRV corresponding to respiratory sinus arrhythmia (RSA) were quantified and compared. Blood pressure (BP) measurements from physical exams of all subjects were also collected and analyzed. RSA was on average significantly stronger in patients with epilepsy, whereas their mean HR was significantly lower after adjusting for age, body mass index, and sex, consistent with increased parasympathetic tone in these patients. In contrast, diastolic (and systolic) BP at rest was not significantly different, indicating that the sympathetic tone is similar. Remarkably, five additional subjects, initially diagnosed as neurologically normal but with enhanced RSA and lower HR, eventually developed epilepsy, suggesting that increased parasympathetic tone precedes the onset of epilepsy in children. ECG waveforms in epilepsy also displayed significantly longer TP intervals (ventricular diastole) relative to the RR interval. The relative TP interval correlated positively with RSA and negatively with HR, suggesting that these parameters are linked through a common mechanism, which we discuss. Altogether, our results provide evidence for imbalanced autonomic function in generalized epilepsy, which may be a key contributing factor to sudden unexpected death in epilepsy.SUDEP; heart rate variability; cardiac cycle; parasympathetic tone; children EPILEPTIC SEIZURES ARE KNOWN to have profound effects on autonomic function (Wyllie 2015). To quantify these effects, many studies have focused on heart rate (HR) (Behbahani et al.

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“…Gong et al examined the potential of heart rate variability (HRV), which is a 2D neuroimaging signal, as an efficient tool for predicting the onset of epilepsy in children [10]. Although there were many studies regarding the relation between HRV and adult with epilepsy [11,12], the relation between the HRV and the children with epilepsy are seldom explored. The results from this study demonstrated the changes of HRV for the children with refractory epilepsy.…”

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confidence: 99%

Development of multimodal neuroimaging markers for neurological disorders – Part 1

Wong

Wang

Liang

2016

XST

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Multi-modal neuroimaging, including electroencephalography (EEG), magnetoencephalography (MEG), positron emission tomography (PET), magnetic resonance imaging (MRI), Near-infrared spectroscopy (NIRS), and single-photon emission computed tomography (SPECT), have been widely used in the diagnosis of neurological diseases, such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis, etc. Each neuroimaging technique has its own merits, and multi-modal neuroimaging is helpful for further improving the diagnosis accuracy of neurological diseases.This special issue focuses on the development of neuroimaging markers for early diagnosis of neurological disorders. The goal is to provide an overview to the current state-of-the-art advances in disease diagnosis using multi-modal neuroimaging techniques and promote further discussion of applying the imaging technologies in future clinical medicine. This special issue includes 10 research articles that cover a wide range of topics related to recent advances in neuroimaging marker studies of neurological disease, which can be the development and evaluation of new methods for neuroimaging data analysis and their applications. The applications include: combining clinical measures, behavioral performance with neuroimaging data to improve disease screening, diagnosis, progress monitoring, as well as predicting disease prognosis and treatment efficacy.The first part of this special issue includes 5 articles. The first two articles examine the disease-related alterations in resting state of human brain and the next three articles focus on the clinical diagnosis and applications of Electrocardiograph (ECG), digital subtraction angiography (DSA) and computed tomography (CT) in neurological disease. Brief discussion of these studies are as follows.Resting-state fMRI is a functional brain imaging method, which can be used to evaluate regional interactions that occur when a subject is not performing an explicit task [1]. The first two papers address the resting-state fMRI as below. Tan, et al, explored the alterations of regional synchronization in infantile spasm patients during resting state through regional homogeneity analysis [2]. Although

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Autonomic changes following generalized tonic clonic seizures: An analysis of adult and pediatric patients with epilepsy

Cited by 98 publications

References 29 publications

Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Decreased heart rate and enhanced sinus arrhythmia during interictal sleep demonstrate autonomic imbalance in generalized epilepsy

Development of multimodal neuroimaging markers for neurological disorders – Part 1

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