Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy

Yuan, Yuan; Hassel, Jonathan; Doytchinova, Anisiia; Adams, David; Wright, Keith; Meshberger, Chad; Chen, Lan S.; Guerra, Maria P.; Shen, Changyu; Lin, Shien Fong; Everett, Thomas H.; Salanova, Vicenta; Chen, Peng Sheng

doi:10.1016/j.hrthm.2017.07.035

Cited by 26 publications

(8 citation statements)

References 34 publications

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“…5,6 This relationship suggests that increasing heart rate is linked to increased seizure likelihood. In line with this, VNS treatment is generally found to decrease heart rate, albeit on a shorter time scale, 25 consistent with cycle periods where seizures were also less likely. More generally, increased heart rate is associated with increased sympathetic dominance, which has also been linked to epilepsy.…”

Section: Discussionsupporting

confidence: 76%

Multiday cycles of heart rate are associated with seizure likelihood

Karoly

Stirling

Freestone³

et al. 2020

Preprint

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Circadian and multiday rhythms are found across many biological systems, including cardiology, endocrinology, neurology and immunology. In people with epilepsy, epileptic brain activity and seizure occurrence have been found to follow circadian, weekly and monthly rhythms. Understanding the relationship between these cycles of brain excitability and other physiological phenomena can provide new insight into the causes of multiday cycles. The brain-heart link is highly relevant for epilepsy, with implications for seizure prediction, therapy (i.e. vagal nerve stimulation) and mortality (i.e. sudden unexpected death in epilepsy).We report the results from a non-interventional, observational cohort study, Tracking Seizure Cycles. This study quantified multiday cycles of heart rate and seizures in human participants (N=26) using wearable smartwatches and mobile seizure diaries over at least two months (M=6.4, SD=4.0). Participants had an epilepsy diagnosis and uncontrolled or partially controlled seizures. Significant cycles in heart rate were detected using a continuous wavelet transform. Significant co-modulation between heart rate cycles and seizure occurrence were measured from the distributions of seizure likelihood with respect to underlying cycle phase (Omnibus test). Weekly trends were also investigated from a retrospective cohort of continuous video-EEG-ECG records of people (N=29) undergoing diagnostic epilepsy monitoring for at least eight days (M=9.7, SD=1.3).Heart rate cycles were found in all participants, with circadian (100%), about-weekly (88%) and about-monthly (92%) rhythms being the most prevalent. Seizures were significantly locked onto at least one heart rate cycle in 76% of eligible participants. Seizures occurred preferentially during the rising phase of the heart rate cycles. Significant weekly trends were also verified in 52% of the video-EEG-ECG cohort.The existence and prevalence of multiday heart rate cycles may have clinical implications for cardiology. Heart rate cycles showed striking similarities to multiday epileptic rhythms and were co-modulated with seizure likelihood. The relationship between heart rate and seizures is relevant for epilepsy therapy, including seizure forecasting. More broadly, understanding the link between multiday cycles in the heart and brain can shed new light on endogenous physiological rhythms in humans.

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Section: Discussionsupporting

confidence: 76%

Multiday cycles of heart rate are associated with seizure likelihood

Karoly

Stirling

Freestone³

et al. 2020

Preprint

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“…to document a causal relationship between SKNA bursts and arrhythmia clustering. We have previously recorded SKNA in patients with epilepsy but no heart diseases (26). In that study, bursts of SKNA did not induce AF.…”

Section: L I N I C a L M E D I C I N Ementioning

confidence: 79%

Skin sympathetic nerve activity and the temporal clustering of cardiac arrhythmias

Kusayama¹,

Jiang²,

Doytchinova³

et al. 2019

JCI Insight

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“…Interestingly, direct recordings of stellate ganglion nerve activity and vagal nerve activity in an ambulatory dog model of heart failure show a circadian rhythm in sympathetic but not vagal tone to the heart 26 . This is supported by measurements of skin sympathetic nerve activity in epileptic patients 27 . These studies suggest that circadian sympathovagal balance may be largely due to diurnal fluctuations in sympathetic tone.…”

Section: Circadian Rhythm In Sinus Node Pacemakingmentioning

confidence: 84%

Circadian rhythm of cardiac electrophysiology, arrhythmogenesis, and the underlying mechanisms

et al. 2019

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Cardiac arrhythmias are a leading cause of cardiovascular death. It has long been accepted that life-threatening cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation, and sudden cardiac death) are more likely to occur in the morning after waking. It is perhaps less well recognized that there is a circadian rhythm in cardiac pacemaking and other electrophysiological properties of the heart. In addition, there is a circadian rhythm in other arrhythmias, for example, bradyarrhythmias and supraventricular arrhythmias. Two mechanisms may underlie this finding: (1) a central circadian clock in the suprachiasmatic nucleus in the hypothalamus may directly affect the electrophysiology of the heart and arrhythmogenesis via various neurohumoral factors, particularly the autonomic nervous system; or (2) a local circadian clock in the heart itself (albeit under the control of the central clock) may drive a circadian rhythm in the expression of ion channels in the heart, which in turn varies arrhythmic substrate. This review summarizes the current understanding of the circadian rhythm in cardiac electrophysiology, arrhythmogenesis, and the underlying molecular mechanisms.

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Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy

Cited by 26 publications

References 34 publications

Multiday cycles of heart rate are associated with seizure likelihood

Multiday cycles of heart rate are associated with seizure likelihood

Skin sympathetic nerve activity and the temporal clustering of cardiac arrhythmias

Circadian rhythm of cardiac electrophysiology, arrhythmogenesis, and the underlying mechanisms

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