Interictal Cardiovascular Autonomic Responses in Patients with Epilepsy

Isojärvi, Jouko; Ansakorpi, Hanna; Suominen, Kalervo; Tolonen, U.; Repo, Marja; Myllylä, Vilho V.

doi:10.1111/j.1528-1157.1998.tb01394.x

Cited by 87 publications

(75 citation statements)

References 32 publications

(22 reference statements)

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“…Changes in HRV vary between seizure types; for example in temporal lobe seizures, increased sympathetic and decreased vagal heart rate modulation often precedes ictal electroencephalographic (EEG) changes (27)(28)(29). Previous studies have reported diminished interictal HRV in temporal lobe epileptic patients using conventional short and long-term electrocardiogram (ECG) recordings, but general study with focused on changes in heart rate during pre-ictal phase failed, and many aspects of it has remained unclear (25,(30)(31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

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

Behbahani¹,

Dabanloo²,

Nasrabadi³

et al. 2013

Anadolu Kardiyol Derg

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Pre-ictal heart rate variability assessment of epileptic seizures by means of linear and non-linear analyses ABSTRACTObjective: The purpose of the present study was to analyze the effects of epilepsy on the autonomic control of the heart in pre-ictal phase in order to find an algorithm of early detection of seizure onset. Methods: Overall 133 epileptic seizures were analyzed from 12 patients with epilepsy (seven males and five females; mean age 43.91 years, SD: 10.16) participated in this study. Single lead electrocardiogram recordings of epileptic patients were compiled. 240, 90-30, 30-10 and 5 minutes heart rate variability (HRV) signals of preseizure were chosen for analysis of heart rate. As HRV signals are non-stationary, a set of time and frequency domain features (Mean HR, Triangular Index, LF, HF, LF/HF) and nonlinear parameters (SD1, SD2 and SD2/SD1 indices derived from Poincaré plots) extracted from HRV is analyzed. Statistical analysis was performed using paired sample t-test for comparisons of the segments and differences between pre-ictal segments were evaluated by Tukey tests. Results: There was slight tachycardia in segments near the seizure (30 minutes before: 85.3517 bpm, 5 minutes before: 119.3630.82 bpm, p=0.0207) which significantly differ from baseline in segments far from seizure (240 minutes before: 66.5211.7 bpm). Also there was significant increase in LF/ HF ratio (30 minutes before: 1.10.22, 5 minutes before: 2.120.5, p=0.0332) and SD2/SD1 ratio (30 minutes before: 1.20.15, 5 minutes before: 2.030.55, p=0.0431) when compared to segments far from the seizure (240 minutes before: 0.780.24 and 0.780.14) respectively. Although there was about decrease of triangular index in segments near the seizure the percentage of decrease was not comparable to segments far from the seizure. Conclusion: Significant changes of HRV parameters in pre-ictal (5 minutes before the seizure) are obviously higher in comparison to interictal baseline. Pre-ictal significant changes of HRV suggesting that this time can be considered as prediction time for designing an algorithm of early detection of seizure onset based on HRV. (

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Section: Introductionmentioning

confidence: 99%

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

Behbahani¹,

Dabanloo²,

Nasrabadi³

et al. 2013

Anadolu Kardiyol Derg

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“…Variations in blood pressure and heart rate during orthostasis and cold pressor test are significantly higher in patients with partial epilepsy than in control subjects (20)(21)(22). In patients with temporal lobe epilepsy, measurement of heart-rate Hand grip was defined as an increase over the diastolic 11 mmHg Hand grip was defined as an increase, at least in two of systolic, diastolic blood pressure or heart rate Increase in both SBP and DBP parameters more than 20 mmHg Increase in one parameter of SBP or DBP No obvious change in parameters *-p value< 0.05 is considered significant variability from short-term ECG recordings showed cardiovascular dysregulation (20)(21)(22). In these patients, not only heart rate is variability reduced, but also is long-term fractal organization, and complexity of heart rate dynamics is apparently altered (22,23).…”

Section: Discussionmentioning

confidence: 99%

“…Reduced heart rate responses to Valsalva maneuver were noted in patients receiving benzodiazepine agents as monotherapy and in patients receiving benzodiazepine agents during deep breathing (24,25).…”

Section: Discussionmentioning

confidence: 99%

“…For example, interictal autonomic dysfunction (parasympathetic disturbance) could be improved after achieving clinical recovery (21,33). Ansakorpi et al showed that HRV parameters the patients with partial epilepsy came close to those in control group after beginning anticonvulsant drug therapy (20). Thus, we require designing a broader study concerning the effects of antiepileptic agents in patients with autonomic symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Abnormal Vasomotor System Function in Idiopathic Generalized Epileptic Patients

Maghbooli¹,

Langroudi²,

Ghoreishi³

et al. 2014

tnd

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Objective: Autonomic dysfunction is widely recognized in both partial and generalized epilepsies. The aim of this study was to evaluate the vasomotor response in patients with generalized idiopathic epilepsy using clinical autonomic function tests. Ma te ri als and Met hods: Hundred and twenty-four consecutive subjects including 62 idiopathic generalized epileptic patients diagnosed for more than 3 months receiving monotherapy and 62 matched for sex and age healthy controls were assessed in this case-control study. The evaluation of the vasomotor system was made using a questionnaire and autonomic function tests including cold pressor, Valsalva maneuver, mental arithmetic and hand-grip tests. Re sults: Abnormal score of the Cold pressor test was seen in 59.7%, Valsalva maneuver in 64.5% and 33.9% in mental arithmetic test of epileptic patients. These results were different significantly in comparison to control group. If abnormal hand grip test was defined as an increase less than 11 mmHg in diastolic pressure, there was found no significant difference between two groups of case and control, also a few people in control group was reported normal. When abnormality was defined as an increase in only one or none of the parameters of systolic blood pressure, diastolic blood pressure or heart rate, 43.5% in patient group versus 14.5% in controls had abnormal results with statistically significant difference. Conclusion: Vasomotor dysfunction assessed with cardiovascular tests was present in patients with generalized epilepsy. Further research on central and peripheral limbs in association with the breakdown of the system is required. (Turkish Journal of Neurology 2014; 20:126-131)

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“…We defined the Valsalva ratio as the ratio of the longest RRinterval during the first 20 s after blowing into a mouthpiece at a pressure of 40 mm Hg with the glottis open for 15 s to the shortest RR-interval during the strain [17].…”

Section: Autonomic Function Testingmentioning

confidence: 99%

Cardiovascular and cerebrovascular responses to lower body negative pressure in type 2 diabetic patients

Marthol¹,

Zikeli²,

Brown³

et al. 2007

Journal of the Neurological Sciences

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In diabetic patients, vascular disease and autonomic dysfunction might compromise cerebral autoregulation and contribute to orthostatic intolerance. The aim of our study was to determine whether impaired cerebral autoregulation contributes to orthostatic intolerance during lower body negative pressure in diabetic patients.Thirteen patients with early-stage type 2 diabetes were studied. We continuously recorded RR-interval, mean blood pressure and mean middle cerebral artery blood flow velocity at rest and during lower body negative pressure applied at −20 and −40 mm Hg. Spectral powers of RR-interval, blood pressure and cerebral blood flow velocity were analyzed in the sympathetically mediated low (LF: 0.04-0.15 Hz) and the high (HF: 0.15-0.5 Hz) frequency ranges. Cerebral autoregulation was assessed from the transfer function gain and phase shift between LF oscillations of blood pressure and cerebral blood flow velocity. In the diabetic patients, lower body negative pressure decreased the RRinterval, i.e. increased heart rate, while blood pressure and cerebral blood flow velocity decreased. Transfer function gain and phase shift remained stable.Lower body negative pressure did not induce the normal increase in sympathetically mediated LF-powers of blood pressure and cerebral blood flow velocity in our patients indicating sympathetic dysfunction. The stable phase shift, however, suggests intact cerebral autoregulation. The dying back pathology in diabetic neuropathy may explain an earlier and greater impairment of peripheral vasomotor than cerebrovascular control, thus maintaining cerebral blood flow constant and protecting patients from symptoms of presyncope.

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Interictal Cardiovascular Autonomic Responses in Patients with Epilepsy

Cited by 87 publications

References 32 publications

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

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

Abnormal Vasomotor System Function in Idiopathic Generalized Epileptic Patients

Cardiovascular and cerebrovascular responses to lower body negative pressure in type 2 diabetic patients

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