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

Rokia Ghchime,Halima Benjelloun,Hajar Kiai,Fatiha Lahjouji,Reda Ouazzani,Halima Belaidi

doi:10.1155/2016/7417540

Rokia Ghchime, Halima Benjelloun + Show 4 more

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https://doi.org/10.1155/2016/7417540

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Abstract

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).

Highlights

Temporal lobe epilepsy (TLE) is well known to be associated with autonomic nervous system dysfunctions [1, 2]
The interval between the different tests was standardized so that the following test did not start until the heart rate (HR) and blood pressure (BP) had returned to the baseline level after the preceding test
The epilepsy type was classified according to the recommendations of the International League Against Epilepsy (ILAE) [23,24,25]

Summary

Introduction

Temporal lobe epilepsy (TLE) is well known to be associated with autonomic nervous system dysfunctions [1, 2]. Autonomic cardiovascular functions are mainly regulated by cortical, midbrain, and brainstem areas [5, 6]. The vital cortical area is the insular cortex folding into the inner temporal lobe that is often dysfunctional in TLE. Lesions of the insular cortex are usually associated with abnormalities in heart rate (HR) and blood pressure (BP) regulation as well as with cardiac arrhythmia [7]. Several studies indicate that the insular cortex and temporal lobe are powerful in the control of cardiovascular function in humans [7,8,9,10]

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