Periictal heart rate variability analysis suggests long-term postictal autonomic disturbance in epilepsy

Tóth, V. and Hejjel, L. and Fogarasi, A. and Gyimesi, Cs. and Orsi, G. and Szűcs, A. and Kovács, N. and Komoly, S. and Janszky, J. and Ebner, A. (2010) Periictal heart rate variability analysis suggests long-term postictal autonomic disturbance in epilepsy. European Journal of Neurology, 17 (6). pp. 780-787. ISSN 1351-5101 (print), 1468-1331 (online)

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Abstract

Background: One of the possible pathomechanisms of sudden death in epilepsy (SUDEP) is a postictal dysregulation of autonomic nervous system. We performed a heart rate variability (HRV) analysis of the periictal state to analyze whether a cardiac autonomic disturbance exists after an epileptic seizure. Methods: We included 31 periictal video–EEG–ECG recordings of 31 patients with epilepsy who had consecutively undergone pre-surgical evaluation. Nine generalized tonic-clonic (GTCS), 15 complex partial, and seven simple motor seizures were included. HRV was evaluated by analyzing 5-min-long ECG epochs, sampling from baseline, direct preictal, early-postictal (<15 min after the seizure), and late-postictal (5–6 h after the seizure) periods. Results: The heart rate was elevated immediately after the seizures, but 5–6 h postictally returned to the baseline level. Time-domain components of HRV decreased after the seizure and this decrease lasted for 5–6 h. Low-frequency power decreased in the early-postictal phase and high-frequency power of HRV dropped in the late-postictal phase. GTCS had an impact on short-term but not on long-term postictal HRV decrease. Conclusions: We found decreased HRV immediately after the seizures, which lasted at least 5–6 h postictally, indicating a long-term postictal disturbance of the autonomous nervous system. GTCS were accompanied by a more decreased HRV than other seizures. Our results may have relevance in explaining pathomechanism of SUDEP.

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