Autonomic symptoms during epileptic seizures

Abstract

Autonomic symptoms frequently occur during epileptic seizures either as an accompaniment to other seizure symptoms or as the predominant seizure manifestation. They do not represent simple reactions to motor manifestations of seizures, but are mediated by an activation of the central autonomic network. Autonomic symptoms can be divided into cardiovascular changes, respiratory manifestations, gastrointestinal symptoms, cutaneous manifestations, pupillary symptoms, genital and sexual manifestations as well as urinary symptoms. Due to a hemispheric‐specific representation of the central autonomic network, certain autonomic symptoms may provide lateralizing and sometimes localizing information on the seizure onset zone, although some of these signs may appear as a result of discharge spreading. Autonomic symptoms indicating a seizure onset in the non‐dominant hemisphere include ictal vomiting and retching, spitting automatisms and ictal urinary urge. Autonomic symptoms range from subtle seizure manifestations which become apparent only during meticulous seizure analysis, to severe, sometimes life‐threatening events. Cardiovascular and respiratory autonomic symptoms are discussed as the mechanisms underlying sudden unexplained death in epilepsy. When autonomic symptoms represent the sole seizure manifestation, they can pose problems for differential diagnosis of various nonepileptic conditions. Finally, autonomic seizure symptoms open a unique window on the functional organization of the central autonomic network and on brain function in general. (Published with videosequences.)

Vagal nerve signals are modulated by spontaneous seizures in Genetic Absence Epilepsy Rats from Strasbourg

“…In 6% of seizures, VNA RMS decreased compared to baseline; in 14%, it showed a slight increase (up to 20%); 80% of seizures showed an increase greater than 20%, and in 44% of cases, the rise exceeded 80%. While autonomic homeostasis relies on parasympathetic and sympathetic balance, seizures often disrupt this equilibrium, triggering autonomic symptoms across cardiovascular, respiratory, gastrointestinal, cutaneous, pupillary, genital, sexual, and urinary domains ( Baumgartner et al, 2001 ). Sakamoto et al (2008) showed that kainic acid-induced seizures in anesthetized rats increase both parasympathetic and sympathetic activities and impair baroreflex function with altered c-Fos expression in medullary regions.…”

Vagal nerve signals are modulated by spontaneous seizures in Genetic Absence Epilepsy Rats from Strasbourg

“…In 6% of seizures, VNA RMS decreased compared to baseline; in 14%, it showed a slight increase (up to 20%); 80% of seizures showed an increase greater than 20%, and in 44% of cases, the rise exceeded 80%. While autonomic homeostasis relies on parasympathetic and sympathetic balance, seizures often disrupt this equilibrium, triggering autonomic symptoms across cardiovascular, respiratory, gastrointestinal, cutaneous, pupillary, genital, sexual, and urinary domains ( Baumgartner et al, 2001 ). Sakamoto et al (2008) showed that kainic acid-induced seizures in anesthetized rats increase both parasympathetic and sympathetic activities and impair baroreflex function with altered c-Fos expression in medullary regions.…”

Predicting Epileptic Seizures From EEG Signals Using Machine Learning

“…Epilepsy, a common chronic neurological disorder affecting approximately 60 million people worldwide, is characterized by unpredictable seizures that can cause injury or death and substantially reduce quality of life [ 5 6 7 ]. EEG contains rich, clinically relevant signatures of seizures, but manual interpretation is time-consuming and requires specialist expertise [ 8 9 ].…”

Seizure Detection Devices

“…Finally, epileptic seizures frequently cause an activation of the central autonomic network comprising the insular cortex, the cingulate cortex, the hypothalamus and the amygdala, resulting in changes of various autonomic parameters, including heart rate, respiration rate, oxygen saturation, skin temperature and sweat secretion [ 48 , 49 , 50 ]. Heart rate can be measured by electrocardiography (ECG) and photoplethysmography (PPG), respiration rate by respiratory monitors, oxygen saturation by pulse oximetry, skin temperature by surface temperature sensors and sweat secretion by electrodermal activity (EDA) [ 11 , 47 ]…”

Vagal nerve signals are modulated by spontaneous seizures in Genetic Absence Epilepsy Rats from Strasbourg

“…In 6% of seizures, VNA RMS decreased compared to baseline; in 14%, it showed a slight increase (up to 20%); 80% of seizures showed an increase greater than 20%, and in 44% of cases, the rise exceeded 80%. While autonomic homeostasis relies on parasympathetic and sympathetic balance, seizures often disrupt this equilibrium, triggering autonomic symptoms across cardiovascular, respiratory, gastrointestinal, cutaneous, pupillary, genital, sexual, and urinary domains ( Baumgartner et al, 2001 ). Sakamoto et al (2008) showed that kainic acid-induced seizures in anesthetized rats increase both parasympathetic and sympathetic activities and impair baroreflex function with altered c-Fos expression in medullary regions.…”

Predicting Epileptic Seizures From EEG Signals Using Machine Learning

“…Epilepsy, a common chronic neurological disorder affecting approximately 60 million people worldwide, is characterized by unpredictable seizures that can cause injury or death and substantially reduce quality of life [ 5 6 7 ]. EEG contains rich, clinically relevant signatures of seizures, but manual interpretation is time-consuming and requires specialist expertise [ 8 9 ].…”

Seizure Detection Devices

“…Finally, epileptic seizures frequently cause an activation of the central autonomic network comprising the insular cortex, the cingulate cortex, the hypothalamus and the amygdala, resulting in changes of various autonomic parameters, including heart rate, respiration rate, oxygen saturation, skin temperature and sweat secretion [ 48 , 49 , 50 ]. Heart rate can be measured by electrocardiography (ECG) and photoplethysmography (PPG), respiration rate by respiratory monitors, oxygen saturation by pulse oximetry, skin temperature by surface temperature sensors and sweat secretion by electrodermal activity (EDA) [ 11 , 47 ]…”

Vagal nerve signals are modulated by spontaneous seizures in Genetic Absence Epilepsy Rats from Strasbourg

“…In 6% of seizures, VNA RMS decreased compared to baseline; in 14%, it showed a slight increase (up to 20%); 80% of seizures showed an increase greater than 20%, and in 44% of cases, the rise exceeded 80%. While autonomic homeostasis relies on parasympathetic and sympathetic balance, seizures often disrupt this equilibrium, triggering autonomic symptoms across cardiovascular, respiratory, gastrointestinal, cutaneous, pupillary, genital, sexual, and urinary domains ( Baumgartner et al, 2001 ). Sakamoto et al (2008) showed that kainic acid-induced seizures in anesthetized rats increase both parasympathetic and sympathetic activities and impair baroreflex function with altered c-Fos expression in medullary regions.…”

Predicting Epileptic Seizures From EEG Signals Using Machine Learning

“…Epilepsy, a common chronic neurological disorder affecting approximately 60 million people worldwide, is characterized by unpredictable seizures that can cause injury or death and substantially reduce quality of life [ 5 6 7 ]. EEG contains rich, clinically relevant signatures of seizures, but manual interpretation is time-consuming and requires specialist expertise [ 8 9 ].…”

Seizure Detection Devices

“…Finally, epileptic seizures frequently cause an activation of the central autonomic network comprising the insular cortex, the cingulate cortex, the hypothalamus and the amygdala, resulting in changes of various autonomic parameters, including heart rate, respiration rate, oxygen saturation, skin temperature and sweat secretion [ 48 , 49 , 50 ]. Heart rate can be measured by electrocardiography (ECG) and photoplethysmography (PPG), respiration rate by respiratory monitors, oxygen saturation by pulse oximetry, skin temperature by surface temperature sensors and sweat secretion by electrodermal activity (EDA) [ 11 , 47 ]…”