Heart rate changes in partial seizures: analysis of influencing factors among refractory patients

Abstract

BackgroundWe analyzed the frequency of heart rate (HR) changes related to seizures, and we sought to identify the influencing factors of these changes during partial seizures, to summarize the regularity of the HR changes and gain some insight into the mechanisms involved in the neuronal regulation of cardiovascular function. To date, detailed information on influencing factors of HR changes related to seizures by multiple linear regression analysis remains scarce.MethodsUsing video-electroencephalograph (EEG)-electrocardiograph (ECG) recordings, we retrospectively assessed the changes in the HR of 81 patients during a total of 181 seizures, including 27 simple partial seizures (SPS), 110 complex partial seizures (CPS) and 44 complex partial seizures secondarily generalized (CPS-G). The epileptogenic focus and the seizure type, age, gender, and sleep/wakefulness state of each patient were evaluated during and after the seizure onset. The HR changes were evaluated in the stage of epilepsy as time varies.ResultsOf the 181 seizures from 81 patients with ictal ECGs, 152 seizures (83.98%) from 74 patients were accompanied by ictal tachycardia (IT). And only 1 patient was accompanied by ictal bradycardia (IB). A patient has both IT and IB. We observed that HR difference was independently correlated with side, type and sleep/wakefulness state. In this analysis, the HR changes were related to the side, gender, seizure type, and sleep/wakefulness state. Right focus, male, sleep, and CPS-G showed more significant increases than that were observed in left, female, wakefulness, SPS and CPS. HR increases rapidly within 10 seconds before seizure onset and ictus, and typically slows to normal with seizure offset.ConclusionCPS-G, sleep and right focus led to higher ictal HR. The HR in the stage of epilepsy has regularly been observed to change to become time-varying. The risk factors of ictal HR need to be controlled along with sleep, CPS-G and right focus. Our study first explains that the HR in seizures has a regular evolution varying with time. Our study might help to further clarify the basic mechanisms of interactions between heart and brain, making seizure detection and closed-loop systems a possible therapeutic alternative in refractory patients.

Tuberous sclerosis presenting with tachycardia as an autonomic phenomenon of epilepsy

“…On average, HR changes by >30 beats/min during seizures, which is consistent with a relative change of >50% compared with baseline rates . Several studies have described the occurrence of HR changes before seizure onset . Chen et al .…”

“…Epileptic discharges directly influence areas of the central autonomic network, thus regulating heart rate (HR) and rhythm . The average ratios of generalized and partial seizures associated with significant changes in HR are 64% and 71%, respectively .…”

“…Epileptic discharges directly influence areas of the central autonomic network, thus regulating heart rate (HR) and rhythm. [1][2][3][4][5] The average ratios of generalized and partial seizures associated with significant changes in HR are 64% and 71%, respectively. 4 On average, HR changes by >30 beats/min during seizures, which is consistent with a relative change of >50% compared with baseline rates.…”

“…4 Several studies have described the occurrence of HR changes before seizure onset. 4,5 Chen et al reported that HR increases rapidly in the 10 s before seizure onset and ictus, and typically slowed to normal with seizure offset. 5 Early detection of these changes can have an application in seizure detection systems.…”

“…4,5 Chen et al reported that HR increases rapidly in the 10 s before seizure onset and ictus, and typically slowed to normal with seizure offset. 5 Early detection of these changes can have an application in seizure detection systems. 5 The tachycardia in the present case was an autonomic cardiac symptom of partial seizures, but this was difficult to discern because it had consistently been the main symptom.…”