Abstract
Purpose Epileptic seizures are frequently accompanied by alterations of autonomic function. Previous studies have suggested that especially changes in heart rate (HR) may help to distinguish epileptic from psychogenic, non-epileptic seizures (PNES). Some of these studies may be confounded by various features such as age, gender, state of wakefulness and seizure semiology. Here, we re-assessed periictal HR modulation in temporal lobe seizures (TLES) and PNES adjusted for a number of known confounders. Methods We retrospectively reviewed video-EEG data of people with refractory temporal lobe epilepsy undergoing presurgical assessment and of age- and gender matched patients without known epilepsy presenting with PNES. One seizure per patient was analyzed. HR was assessed with the help of a one-channel ECG lead at different time points (2 min before, during the seizure where HR was highest, immediately after seizure cessation, and 1, 2, 3, 5 and 10 min postictally). Data are given as mean ± SD. Results A total of 189 of patients and seizures were included in the study. Sixty TLES arising from wakefulness (20 men, 34 ± 12 years) and 129 PNES were analyzed. In the PNES group, 60 of the seizures had occurred spontaneously from wakefulness (PNES-S, 20 men, 37 ± 14 years), while 69 were induced by a provocation maneuver (verbal suggestion along with intravenous injection of vitamins; PNES-P, 23 men, 36 ± 14 years). In the PNES-P group, baseline HR was significantly higher as compared to the two other groups (p Conclusions TLES display higher relative HR changes during non-motor seizures as well as shortly after major motor and non-motor seizures, as compared to PNES-S. The setting of a provocation maneuver itself appears to enhance baseline HR. Taken together, our results support the notion that analysis of periictal HR is helpful in the differential diagnosis of epileptic versus psychogenic, non-epileptic seizures.
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