국소관련간질 환자의 발작 전후 심박수 변화 = Peri-ictal Heart Rate Changes in Patients With Localization-Related Epilepsy

다국어 초록 (Multilingual Abstract)

Background: Epileptic seizures can be associated with changes in autonomic functions. This study evaluated heart rate (HR) changes at the transition from the preictal to the ictal state in patients with epileptic seizures, and investigated whether peri-ictal HR changes can help to predict electroencephalography (EEG) seizures prior to their onset.
Methods: We retrospectively studied 94 seizures in 33 patients who underwent video-EEG monitoring with scalp EEG and electrocardiography. The existence and initial timing of HR changes relative to the onset of EEG seizures were determined by analyzing consecutive RR-interval changes in 10-minute recordings. We evaluated the correlation between the peri-ictal HR changes and the type of localization-related epilepsy.
Results: Peri-ictal HR changes were documented in 70.2% (66/94) of all seizures, of which 62 were tachycardia (66.0%)and 4 were bradycardia (4.3%). Peri-ictal tachycardia occurred significantly with seizures as an ictal manifestation, more often in seizures with a right hemispheric onset than in those with a left hemispheric onset (77.4% vs. 50%, p=0.016).
Peri-ictal HR changes were observed much earlier in seizures of mesial temporal lobe epilepsy (TLE) than in those of extratemporal lobe epilepsy (–54.4 s vs. –6.7 s, p<0.001).
Conclusions: Peri-ictal HR changes were observed in 70.2% of seizures, 94% of which were tachycardia. These changes could be helpful in predicting seizure onset, especially in mesial TLE.

참고문헌 (Reference)

1 Opherk C, "eart rate and EKG changes in 102 seizures: analysis of influencing factors" 52 : 117-127, 2002

2 Zamrini EY, "Unilateral cerebral inactivation produces differential left/right heart rate responses" 40 : 1408-1411, 1990

3 Press WH, "Numerical recipes in C: the art of scientific computing. 2nd ed" Cambridge University Press 105-116, 1992

4 Petelczyc M, "Kramers-Moyal coefficients in the analysis and modeling of heart rate variability" 80 : 031127-, 2009

5 Garcia M, "Ictal tachycardia: its discriminating potential between temporal and extratemporal seizure foci" 10 : 415-419, 2001

6 Marshall DW, "Ictal tachycardia during temporal lobe seizures" 58 : 443-446, 1983

7 Weil S, "Heart rate increase in otherwise subclinical seizures is different in temporal versus extratemporal seizure onset: support for temporal lobe autonomic influence" 7 : 199-204, 2005

8 Zijlmans M, "Heart rate changes and ECG abnormalities during epileptic seizures: prevalence and definition of an objective clinical sign" 43 : 847-854, 2002

9 Di Gennaro G, "Grammaldo LG, et al. Ictal heart rate increase precedes EEG discharge in drugresistant mesial temporal lobe seizures" 115 : 1169-1177, 2004

10 Keilson MJ, "Electrocardiographic changes during electrographic seizures" 46 : 1169-1170, 1989

11 Leutmezer F, "Electrocardiographic changes at the onset of epileptic seizures" 44 : 348-354, 2003

12 Blumhardt LD, "Electrocardiographic accompaniments of temporal lobe epileptic seizures" 1 : 1051-1056, 1986

13 Nei M, "EKG abnormalities during partial seizures in refractory epilepsy" 41 : 542-548, 2000

14 Yoon BW, "Cerebral hemispheric lateralization in cardiac autonomic control" 54 : 741-744, 1997

15 Gelsema AJ, "Cardiovascular responses to chemical and electrical stimulation of amygdala in rats" 253 : 712-718, 1987

16 Oppenheimer SM, "Cardiovascular effects of human insular cortex stimulation" 42 : 1727-1732, 1992

17 Epstein MA, "Cardiac rhythm during temporal lobe seizures" 42 : 50-53, 1992

18 Baumgartner C, "Autonomic symptoms during epileptic seizures" 3 : 103-116, 2001

19 Yasui Y, "Autonomic responses and efferent pathways from the insular cortex in the rat" 303 : 355-374, 1991

20 Schernthaner C, "Autonomic epilepsy-the influence of epileptic discharges on heart rate and rhythm" 111 : 392-401, 1999

21 Park HY, "Alterations of vestibuloocular reflex and heart rate variability by sinusoidal rotation in adults" 17 : 541-547, 1999