Abstract
Background and Objectives: Abnormal epileptic discharges in the brain can affect the central brain regions that regulate autonomic activity and produce cardiac symptoms, either at onset or during propagation of a seizure. These autonomic alterations are related to cardiorespiratory disturbances, such as sudden unexpected death in epilepsy. This study aims to investigate the differences in cardiac autonomic function between patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) using ultra-short-term heart rate variability (HRV) analysis around seizures. Materials and Methods: We analyzed electrocardiogram (ECG) data recorded during 309 seizures in 58 patients with epilepsy. Twelve patients with FLE and 46 patients with TLE were included in this study. We extracted the HRV parameters from the ECG signal before, during and after the ictal interval with ultra-short-term HRV analysis. We statistically compared the HRV parameters using an independent t-test in each interval to compare the differences between groups, and repeated measures analysis of variance was used to test the group differences in longitudinal changes in the HRV parameters. We performed the Tukey–Kramer multiple comparisons procedure as the post hoc test. Results: Among the HRV parameters, the mean interval between heartbeats (RRi), normalized low-frequency band power (LF) and LF/HF ratio were statistically different between the interval and epilepsy types in the t-test. Repeated measures ANOVA showed that the mean RRi and RMSSD were significantly different by epilepsy type, and the normalized LF and LF/HF ratio significantly interacted with the epilepsy type and interval. Conclusions: During the pre-ictal interval, TLE patients showed an elevation in sympathetic activity, while the FLE patients showed an apparent increase and decrease in sympathetic activity when entering and ending the ictal period, respectively. The TLE patients showed a maintained elevation of sympathetic and vagal activity in the pos-ictal interval. These differences in autonomic cardiac characteristics between FLE and TLE might be relevant to the ictal symptoms which eventually result in SUDEP.
Highlights
Epilepsy is the second-most functionally distressing neurological disease worldwide and affects 6.38 out of 1000 people [1,2]
The low-frequency band power (LF)/HF ratio was significantly distinct in the ictal interval (p = 0.010)
The standard deviation of all RR intervals (SDNN) is related to the activity of both the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS), and it is highly correlated with the LF band power and total power [59]
Summary
Epilepsy is the second-most functionally distressing neurological disease worldwide and affects 6.38 out of 1000 people [1,2]. Abnormal epileptic discharges in the brain can affect the central brain regions that regulate autonomic activity and cause these cardiac symptoms, either at onset or during propagation of a seizure [12] These autonomic alterations that are related to cardiorespiratory disturbances, such as tachycardia, bradycardia or asystole, can result in sudden unexpected death in epilepsy (SUDEP) [12,13,14,15,16]. Abnormal epileptic discharges in the brain can affect the central brain regions that regulate autonomic activity and produce cardiac symptoms, either at onset or during propagation of a seizure These autonomic alterations are related to cardiorespiratory disturbances, such as sudden unexpected death in epilepsy.
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