Analysis of heart rate variability and risk factors for SUDEP in patients with drug-resistant epilepsy

Baysal-Kıraç, Leyla; Serbest, Nail Guven; Şahin, Erdi; Dede, Hava Özlem; Gürses, Candan; Gökyiğit, Ayşen; Bebek, Nerses; Bilge, Ahmet Kaya; Baykan, Betül

doi:10.1016/j.yebeh.2017.04.018

Cited by 42 publications

(38 citation statements)

References 42 publications

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“…There have been a number of studies of interictal HRV in more heterogeneous adult epilepsy populations. Most have reported trends indicating a shift toward sympathetic dominance, although some failed to find statistically significant differences . In similarly designed studies of pediatric patients, the same patterns are typically seen, although children with drug‐resistant epilepsy often have more severe derangements …”

Section: Interictal Hrv Patterns In Different Epilepsy Typesmentioning

confidence: 95%

“…One of the primary reasons for the enthusiasm for investigation of HRV in epilepsy is the potential to better understand SUDEP. This entity is thought to at least partially relate to autonomic dysfunction, and 3 studies have shown correlation of SUDEP risk factors with more severely deranged HRV, although a third did not find a significant correlation . Postictal EEG suppression may potentially be a biomarker of SUDEP, and in one study was associated with decreased HF power .…”

Section: Sudden Unexpected Death In Epilepsymentioning

confidence: 96%

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Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

2018

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Our objective was to critically evaluate the literature surrounding heart rate variability (HRV) in people with epilepsy and to make recommendations as to how future research could be directed to facilitate and accelerate integration into clinical practice. We reviewed relevant HRV publications including those involving human subjects with seizures. HRV has been studied in patients with epilepsy for more than 30 years and, overall, patients with epilepsy display altered interictal HRV, suggesting a shift in autonomic balance toward sympathetic dominance. This derangement appears more severe in those with temporal lobe epilepsy and drug-resistant epilepsy. Normal diurnal variation in HRV is also disturbed in at least some people with epilepsy, but this aspect has received less study. Some therapeutic interventions, including vagus nerve stimulation and antiepileptic medications, may partially normalize altered HRV, but studies in this area are sometimes contradictory. During seizures, the changes in HRV may be complex, but the general trend is toward a further increase in sympathetic overactivity. Research in HRV in people with epilepsy has been limited by inconsistent experimental protocols and studies that are often underpowered. HRV measurement has the potential to aid clinical epilepsy management in several possible ways. HRV may be useful in predicting which patients are likely to benefit from surgical interventions such as vagus nerve stimulation and focal cerebral resection. As well, HRV could eventually have utility as a biomarker of risk for sudden unexpected death in epilepsy (SUDEP). However, at present, the inconsistent measurement protocols used in research are hindering translation into clinical practice. A minimum protocol for HRV evaluation, to be used in all studies involving epilepsy patients, is necessary to eventually allow HRV to become a useful tool for clinicians. We propose a straightforward protocol, involving 5-minute measurements of root mean square of successive differences in wakefulness and light sleep.

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Section: Interictal Hrv Patterns In Different Epilepsy Typesmentioning

confidence: 95%

Section: Sudden Unexpected Death In Epilepsymentioning

confidence: 96%

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

2018

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“…A vast literature exists on clinical epilepsy-associated changes in heart rate variability (e.g., reviewed by [57,58,68]). Whereas chronic TLE proved to be associated with lower heart rate variability (e.g., [14,[69][70][71]), a study in patients with new onset untreated epilepsy did not reveal disease-associated alterations in heart rate variability [72]. The lack of changes in heart rate variability in kindled rats might actually reflect these data, as a short kindling paradigm might rather model the early phase following epilepsy manifestation in patients.…”

Section: Discussionmentioning

confidence: 94%

Impact of repeated kindled seizures on heart rate rhythms, heart rate variability, and locomotor activity in rats

Möller

Dijk

Wolf

et al. 2019

Epilepsy & Behavior

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Although an impact of epilepsy on circadian rhythmicity is well-recognized, there are profound gaps in our understanding of the influence of seizures on diurnal rhythms. The effect on activity levels and heart rate is of particular interest as it might contribute to the disease burden. The kindling model with telemetric transmitter implants provides excellent opportunities to study the consequences of focal and generalized seizures under standardized conditions. Data from kindled rats with generalized seizures revealed an increase in activity and heart rate during the resting phase. Total and short-term heart rate variabilities were not affected by electrode implantation or seizure induction. Ictal alterations in heart rate associated with generalized seizures were characterized by a biphasic bradycardia with an immediate drop of heart rate followed by a transient normalization and a second more steady decrease. In conclusion, the findings demonstrate that once daily generalized seizures can exert significant effects on heart rate rhythms. Respective alterations in patients would be of relevance for patient counselling and therapeutic management. Occurrence of biphasic bradycardia associated with seizure induction suggests that the kindling model is suitable to study the consequences and the prevention of ictal bradycardia, which may pose patients at risk for sudden unexpected death.

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“…after acute myocardial infarction, in heart failure, diabetic neuropathy, and stroke [88]. Subsequent studies have also shown that patients with drug-resistant epilepsy have both increased heart rates and lower HRV measures, which indicate a high probability that sudden cardiac death may be the cause of SUDEP in some patients [89]. Other investigators have indicated that epilepsy patients with sodium channel (SCN) gene mutations have severe ANS dysfunction characterized by lower HRV, suggesting HRV as a potential biomarker for SUDEP risk [90].…”

Section: Heart Rate Variability / T-wave Alternansmentioning

confidence: 99%

Sudden unexpected death in epilepsy: The neuro-cardio-respiratory connection

Manolis

Melita

et al. 2019

Seizure

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Analysis of heart rate variability and risk factors for SUDEP in patients with drug-resistant epilepsy

Cited by 42 publications

References 42 publications

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

Impact of repeated kindled seizures on heart rate rhythms, heart rate variability, and locomotor activity in rats

Sudden unexpected death in epilepsy: The neuro-cardio-respiratory connection

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