Comparing maximum autonomic activity of psychogenic non-epileptic seizures and epileptic seizures using heart rate variability

Jeppesen, Jesper; Beniczky, Sándor; Johansen, Peter; Sidenius, Per; Fuglsang-Frederiksen, Anders

doi:10.1016/j.seizure.2016.02.005

Cited by 28 publications

(17 citation statements)

References 15 publications

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“…In many cases, these studies have been conducted with the goal of developing seizure prediction devices; the observation of HRV changes prior to clinical seizure onset suggests this could be useful . In addition, some studies have found subtle differences when comparing ictal HRV in epileptic seizures and PNES; however, the wide interindividual variability suggests that at this point HRV would not be a useful tool in differentiating the 2 event types.…”

Section: Periictal Patternsmentioning

confidence: 99%

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

2018

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Our objective was to critically evaluate the literature surrounding heart rate variability (HRV) in people with epilepsy and to make recommendations as to how future research could be directed to facilitate and accelerate integration into clinical practice. We reviewed relevant HRV publications including those involving human subjects with seizures. HRV has been studied in patients with epilepsy for more than 30 years and, overall, patients with epilepsy display altered interictal HRV, suggesting a shift in autonomic balance toward sympathetic dominance. This derangement appears more severe in those with temporal lobe epilepsy and drug-resistant epilepsy. Normal diurnal variation in HRV is also disturbed in at least some people with epilepsy, but this aspect has received less study. Some therapeutic interventions, including vagus nerve stimulation and antiepileptic medications, may partially normalize altered HRV, but studies in this area are sometimes contradictory. During seizures, the changes in HRV may be complex, but the general trend is toward a further increase in sympathetic overactivity. Research in HRV in people with epilepsy has been limited by inconsistent experimental protocols and studies that are often underpowered. HRV measurement has the potential to aid clinical epilepsy management in several possible ways. HRV may be useful in predicting which patients are likely to benefit from surgical interventions such as vagus nerve stimulation and focal cerebral resection. As well, HRV could eventually have utility as a biomarker of risk for sudden unexpected death in epilepsy (SUDEP). However, at present, the inconsistent measurement protocols used in research are hindering translation into clinical practice. A minimum protocol for HRV evaluation, to be used in all studies involving epilepsy patients, is necessary to eventually allow HRV to become a useful tool for clinicians. We propose a straightforward protocol, involving 5-minute measurements of root mean square of successive differences in wakefulness and light sleep.

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Section: Periictal Patternsmentioning

confidence: 99%

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

2018

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“…However, they are rarely used in clinical settings, because they are only applicable when the patients already has a baseline level for comparison. In addition, heart rate variability (HRV) change during seizure has drawn great interest; however, there were no statistical differences in HRV parameters between PNES and epilepsy patients . Recently, a pilot study also investigated the possibility of using postictal ammonia to help differentiate between PNES and ES, with the sample drawn within a limited window of 15–60 min after the event .…”

Section: Discussionmentioning

confidence: 69%

Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting

Matzka

Maranda

et al. 2017

Epilepsia

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Differentiation between psychogenic nonepileptic seizures (PNES) and generalized convulsive epileptic seizures (ES) is important for appropriate triaging in the emergency department (ED). This can be difficult in the ED, as the event is often not witnessed by a medical professional. In the current study, we investigated whether anion gap (AG), bicarbonate, and the Denver Seizure Score (DSS) could differentiate between PNES and ES. Of a total of 1,354 subjects reviewed from a tertiary care medical center, 27 PNES and 27 ES patients were identified based on clinical description and subsequent electroencephalogram. Multivariate logistic regression analysis and receiver operating characteristic curves were used to determine whether there was an association between seizure type and AG, bicarbonate, or DSS (24-bicarbonate + 2 × [AG-12]) when samples were drawn within 24 h of the concerning event. The result showed that sensitivity and negative predictive value dropped markedly for all measures if samples were drawn >2 h after the event; the sensitivity was similar for AG and DSS and higher than for bicarbonate. We propose that AG > 10 (sensitivity of 81.8%, specificity of 100%) in the first 2 h after the event could be used as a potential tool in the ED to help differentiate between PNES and ES.

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“…In studies, it was found that sympathetic tone was significantly higher in epileptic seizures than in non-epileptic seizures. Therefore, detailed VEEG and ECG monitoring play an important role in the differential diagnosis (15,16).…”

Section: A the Cardiopulmonary System And Autonomic Epilepsymentioning

confidence: 99%

Seizures with Autonomic Symptoms and Sudden Unexpected Death in Epilepsy (SUDEP)

Çeli¹,

Özkara²

2019

tnd

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The autonomic nervous system, formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of internal organs. The hypothalamus is the main center responsible for the autonomic functions in the central nervous system. Other anatomical structures can be listed as cingulate gyrus, amygdala, paraventricular nucleus. The central autonomic network involved in the pathophysiology of autonomous epilepsy is represented in the non-dominant hemisphere. Autonomic seizures are shown in temporal and insular lobe epilepsies commonly. Blood pressure changes, heart rhythm disturbances (tachycardia, bradycardia, arrhythmia, asystole), respiratory changes (apnea, hypopnea, bradypnea), salivation increase, vomiting/retching, pilo-erection, sweating increase, mydriasis/miosis, spitting, water drinking, genital automatism, intestinal motility disorders are clinical signs in autonomic epilepsy. SUDEP (sudden unexpected death in epilepsy) is defined as sudden, unexpected, nontraumatic, non-drowning death in an individual with epilepsy, witnessed or unwitnessed, in which post-mortem examination does not reveal an anatomical or toxicological cause of death. The vast majority of SUDEPs occur in the aftermath of a generalised tonic-clonic seizure. It's responsible for 17% of deaths in epileptic patients. Witnessed recorded SUDEP cases involve postictal cardiorespiratory dysfunction with failure of arousal. It is reported that the threshold value of SpO 2 is 80-86% for the risk of sudden death. While patients who have had seizures remotely and have had successful epilepsy surgeries also carry the SUDEP risk, the most important risk factor is a history of generalised tonic-clonic seizures.

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Comparing maximum autonomic activity of psychogenic non-epileptic seizures and epileptic seizures using heart rate variability

Cited by 28 publications

References 15 publications

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting

Seizures with Autonomic Symptoms and Sudden Unexpected Death in Epilepsy (SUDEP)

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