Heart rate dynamics in refractory and well controlled temporal lobe epilepsy

Abstract

Objectives: Disorders of cardiovascular and other autonomic nervous system functions are often found in patients with temporal lobe epilepsy (TLE). Cardiovascular dysregulation in TLE has previously been quantified assessing traditional time and frequency domain measures of heart rate (HR) variability from short term ECG recordings. However, new complexity and fractal measures of HR variability based on non-linear dynamics and fractals ("chaos theory") may disclose certain patterns of HR dynamics that cannot be detected using only conventional measures. Methods: In addition to the traditional spectral and non-spectral components of HR variability, fractal correlation properties, approximate entropy (ApEn) of RR interval dynamics, and the slope of the power law relation were measured from 24 hour ambulatory ECG recordings to evaluate interictal autonomic cardiovascular regulatory function in 19 patients with refractory TLE, 25 patients with well controlled TLE, and in 34 healthy age and sex matched control subjects. Results: The traditional time and frequency domain measures were lower in patients with TLE than in controls (p<0.05). In addition, the power law slope (p<0.005) and ApEn (p<0.05) were also reduced in TLE patients. Furthermore, ApEn was smaller in patients with refractory TLE than in patients with wellcontrolled TLE ( p<0.01), whereas the long term fractal correlation value α2 was lower in patients with well controlled TLE (p<0.05). An altered HR variation was not associated with any particular AED regimen. Conclusions: In addition to reduced overall HR variability, the long term fractal organisation and complexity of HR dynamics seem to be altered in TLE. These abnormalities in HR behaviour may partly contribute to the occurrence of adverse cardiovascular events, such as life threatening arrhythmias in patients with TLE.

Altered physiological brain variation in drug‐resistant epilepsy

“…The pulsation abnormality becomes evident as abnormal signal variation in the specific physiological frequency bands, especially respiratory and very low frequencies. These frequencies further overlap with autonomic disturbances known to be present in epilepsy (Ansakorpi et al., 2002, 2011; Liu et al., 2017; Suorsa et al., 2011; van der Kruijs et al., 2016). …”

Pre-ictal heart rate variability assessment of epileptic seizures by means of linear and non-linear analyses

“…On the other hand, with respect to nonlinear HRV analysis, to the best of our knowledge, only a few research groups applied nonlinear HRV on epilepsy patients and unfortunately, these researches are restricted to special types of epilepsy like temporal lobe or refractory epilepsy (10,16,(44)(45)(46)(47)(48). It is important to note that nonlinear HRV techniques will not replace linear analysis, but have to be considered as a completion.…”

“…Dysfunction of the autonomous nervous system (ANS) has been reported in humans with epileptic seizures and in animal models (10)(11)(12)(13)(14)(15)(16). This dysfunction results in higher morbidity and mortality in patients with epilepsy than in those without epilepsy (17).…”

Uncommon Clinical Manifestations of Cysticercosis

“…However, the cardiac signs found in our series such as: asystole and bradycardia may also be suggestive of cardiac dysfunction secondary to left insula as has previously been reported in patients with temporal lobe epilepsy [195][196][197][198] and confirmed in 2009 by Koseoglu et al [199] The epileptic activity spreads through the limbic system with the involvement of the amygdala, hypothalamus, and thalamus. These, in turn stimulate the autonomic system at medullar level including the nucleus tractus solitarius and the nucleus ambiguous which generate sympathetic and parasympathetic discharges.…”