Supression of cardiac parasympathetic functions in patients with right hemispheric stroke

Erciyas, Ali Haydar; Topalkara, Kamil; Topaktaş, Suat; Akyüz, Aytekin; Dener, Sefik

doi:10.1046/j.1468-1331.1999.660685.x

Cited by 19 publications

(9 citation statements)

References 18 publications

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“…A clinical diagnosis and detailed medical history were carried out with special emphasis on types of AEDs taken, interictal EEG recordings, and cranial and hippocampal MRI. The epilepsy type was classified according to the recommendations of the International League Against Epilepsy (ILAE) [ 23 – 25 ].…”

Section: Resultsmentioning

confidence: 99%

Cerebral Hemispheric Lateralization Associated with Hippocampal Sclerosis May Affect Interictal Cardiovascular Autonomic Functions in Temporal Lobe Epilepsy

Ghchime¹,

Benjelloun

H³

et al. 2016

Epilepsy Research and Treatment

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It is well established that the temporal lobe epilepsy (TLE) is linked to the autonomic nervous system dysfunctions. Seizures alter the function of different systems such as the respiratory, cardiovascular, gastrointestinal, and urogenital systems. The aim of this work was to evaluate the possible factors which may be involved in interictal cardiovascular autonomic function in temporal lobe epilepsy with complex partial seizures, and with particular attention to hippocampal sclerosis. The study was conducted in 30 patients with intractable temporal lobe epilepsy (19 with left hippocampal sclerosis, 11 with right hippocampal sclerosis). All subjects underwent four tests of cardiac autonomic function: heart rate changes in response to deep breathing, heart rate, and blood pressure variations throughout resting activity and during hand grip, mental stress, and orthostatic tests. Our results show that the right cerebral hemisphere predominantly modulates sympathetic activity, while the left cerebral hemisphere mainly modulates parasympathetic activity, which mediated tachycardia and excessive bradycardia counterregulation, both of which might be involved as a mechanism of sudden unexpected death in epilepsy patients (SUDEP).

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Section: Resultsmentioning

confidence: 99%

Cerebral Hemispheric Lateralization Associated with Hippocampal Sclerosis May Affect Interictal Cardiovascular Autonomic Functions in Temporal Lobe Epilepsy

Ghchime¹,

Benjelloun

H³

et al. 2016

Epilepsy Research and Treatment

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“…These results are indeed significant, since the decreased HRR at 1, 2 and 3 min after exercise is mainly a result of impaired vagal reactivation, a predictor of cardiovascular events [ 45 – 47 ]. Furthermore, decreased vagal tone is found in several conditions and it is generally associated with poor cardiovascular prognosis [ 48 – 50 ]. In fact, HRR after exercise seems to be correlated with heart rate variability in the early recovery phase after submaximal exercise [ 51 , 52 ], reinforcing our findings.…”

Section: Discussionmentioning

confidence: 99%

Cardiac autonomic dysfunction in chronic stroke women is attenuated after submaximal exercise test, as evaluated by linear and nonlinear analysis

Francica

Bigongiari

Mochizuki

et al. 2015

BMC Cardiovasc Disord

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BackgroundWe evaluated cardiac autonomic modulation in women with chronic ischemic stroke (at least 4 years post-stroke) at rest and in response to submaximal exercise test.MethodsFourteen post-stroke women (S group) and 10 healthy women (C group) participated in this study. Autonomic modulation (using linear and nonlinear analysis), blood pressure and metabolic variables at rest were evaluated immediately after the exercise test and during the recovery period (20 min). All participants underwent submaximal exercise test on cycle ergometer with gas analysis.ResultsAt rest, the S group displayed higher lactate concentration, systolic (SBP) and diastolic blood pressure (DBP) values when compared to C group. Furthermore, the S group had lower heart rate variability (HRV) in time domain (SDNN: S = 30 ± 5 vs. 40 ± 8 ms; rMSSD: S = 14 ± 2 vs. C = 34 ± 3 ms), decreased high frequency band of pulse interval (S = 8.4 ± 2 vs. 33.1 ± 9 %) and 2V pattern of symbolic analysis (S = 17.3 ± 1 vs. 30 ± 3 %) (both indicators of cardiac vagal modulation) when compared to C group. Immediately after exercise, S group presented higher values of lactate, SBP, DBP and double product when compared to C group, as well as decreased heart rate recovery (HRR) measured at the first, second and third minutes. At recovery time, all HRV parameters in time and frequency domains improved in the S group; however, HF band remained lower when compared to C group.ConclusionsAfter the exercise test, women with chronic stroke presented reduced heart rate variability, reduced cardiac vagal modulation, as well as reduced HRR, while displayed an improvement of heart rate variability and cardiac vagal modulation when compared to their baseline. These results reinforce the importance of a physically active lifestyle for cardiovascular autonomic disorders observed in chronic stroke women.

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“…Naver [ 29 ] indicated that heart rate variability entrained to deep breathing (a parasympathetic relationship) was reduced with right sided stroke, whereas peripheral sympathetic influences were equally distributed between the two sides. Sympathetic skin response and pulse rate variation (parasympathetic measure) were suppressed in patients with both right or left hemisphere lesions compared with controls [ 11 ]. This effect was more marked with right hemisphere lesions, although the authors failed to show a statistical difference when right and left sides were compared.…”

Section: Cerebral Lateralization Of Cardioregulatory Functionmentioning

confidence: 99%

Cerebrogenic cardiac arrhythmias:

Oppenheimer

2006

Clin Auton Res

247

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Perspective■ Evidence for sympathetic upregulation as a mechanism for cerebral influences on cardiac structure and function In 1913 Goodman Levy [24, 25] showed that chloroforminduced ventricular tachyarrhythmias were abolished by cardiac sympathetic denervation. Additionally, sympathetic activation induced identical ventricular tachyarrhythmias, indicating a direct neurological rather than cardiac effect of chloroform. Subsequently, Beattie [3] showed that these tachyarrhythmias were abolished by mid-collicular, but not higher, diencephalic sectioning. Histological examination indicated degeneration of a pathway originating in the hypothalamus and terminating in the intermediolateral column (close to the cells of origin of sympathetic preganglionic fibers). Another decade passed. Aschenbrenner [1] reported seven young patients with cortical and diencephalic tumors who developed ventricular ectopy or nodal rhythm. These patients lacked cardiac history or post mortem ischemic cardiac pathology to explain their death. Subendocardial hemorrhages adjacent to the ventricular cavity were noted as an unusual feature. These resembled the changes seen after sudden death in epilepsy reported earlier by Neuberger [30].Much of this was forgotten with the advent of World War II. In the aftermath, single case reports of intriguing ECG repolarization changes after subarachnoid hemorrhage (SAH) were reported: inverted T waves (often tall, symmetrical downward peaking) and prolonged QTc interval with ST elevation or depression. Cropp [9] initially thought these changes indicated coronary artery disease and delayed surgery, with fatal consequences. Clinical and pathological findings were reviewed. No patient had a cardiac history, most were young and no autopsied case showed coronary artery pathology. Aneurysm position led to implication of inferior frontal structures and possible vagal mechanisms in the etiology of these cardiac changes.

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Supression of cardiac parasympathetic functions in patients with right hemispheric stroke

Abstract: Supression of vagal parasympathetic activity was more apparent in stroke patients with right hemispheric lesions in our series. Therefore, the right hemisphere seems to have a greater effect upon parasympathetic activity.

Cited by 19 publications

References 18 publications

Cerebral Hemispheric Lateralization Associated with Hippocampal Sclerosis May Affect Interictal Cardiovascular Autonomic Functions in Temporal Lobe Epilepsy

Cerebral Hemispheric Lateralization Associated with Hippocampal Sclerosis May Affect Interictal Cardiovascular Autonomic Functions in Temporal Lobe Epilepsy

Cardiac autonomic dysfunction in chronic stroke women is attenuated after submaximal exercise test, as evaluated by linear and nonlinear analysis

Cerebrogenic cardiac arrhythmias:

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