Titre
Ictal changes in parasympathetic tone: Prediction of postictal oxygen desaturation
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Szurhaj, W.
Auteure/Auteur
Troussière, A.C.
Auteure/Auteur
Logier, R.
Auteure/Auteur
Derambure, P.
Auteure/Auteur
Tyvaert, L.
Auteure/Auteur
Semah, F.
Auteure/Auteur
Ryvlin, P.
Auteure/Auteur
De Jonckheere, J.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1526-632X
Statut éditorial
Publié
Date de publication
2015
Volume
85
Numéro
14
Première page
1233
Dernière page/numéro d’article
1239
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish
Résumé
OBJECTIVE: To measure changes in parasympathetic tone before, during, and after temporal seizures, and to determine whether changes in high-frequency heart rate variability are correlated with postictal oxygen desaturation.
METHODS: We recorded the electrocardiogram and peripheral oxygen saturation during 55 temporal lobe seizures and calculated a high-frequency variability index (HFVI) as a marker of parasympathetic tone for periods of 20 minutes (centered on seizure onset). We then compared HFVI values in seizures with and without postictal hypoxemia, and looked for correlations between HFVI changes and the risk of sudden unexpected death in epilepsy (SUDEP) (as assessed with the SUDEP-7 Inventory).
RESULTS: Parasympathetic tone decreased rapidly at the onset of temporal lobe seizures, reached its minimum value at the end of the seizure, and then gradually returned to its preictal value. Changes in parasympathetic tone were more intense and longer-lasting in older patients with a longer duration of epilepsy. The HFVI was significantly lower during seizures with hypoxemia, and remained significantly lower 5 minutes after the end of the seizure. The change in the HFVI slope over the first 30 seconds of the seizure was predictive of postictal oxygen desaturation. Postictal autonomic changes were correlated with the SUDEP-7 scores.
CONCLUSION: Our results showed that ictal autonomic dysfunction is correlated with postictal hypoxemia. A prolonged impairment of parasympathetic tone might expose a patient to a greater risk of postictal sudden unexpected death. The real-time measurement of parasympathetic tone in patients with epilepsy may be of value to medical staff as an early warning system.
METHODS: We recorded the electrocardiogram and peripheral oxygen saturation during 55 temporal lobe seizures and calculated a high-frequency variability index (HFVI) as a marker of parasympathetic tone for periods of 20 minutes (centered on seizure onset). We then compared HFVI values in seizures with and without postictal hypoxemia, and looked for correlations between HFVI changes and the risk of sudden unexpected death in epilepsy (SUDEP) (as assessed with the SUDEP-7 Inventory).
RESULTS: Parasympathetic tone decreased rapidly at the onset of temporal lobe seizures, reached its minimum value at the end of the seizure, and then gradually returned to its preictal value. Changes in parasympathetic tone were more intense and longer-lasting in older patients with a longer duration of epilepsy. The HFVI was significantly lower during seizures with hypoxemia, and remained significantly lower 5 minutes after the end of the seizure. The change in the HFVI slope over the first 30 seconds of the seizure was predictive of postictal oxygen desaturation. Postictal autonomic changes were correlated with the SUDEP-7 scores.
CONCLUSION: Our results showed that ictal autonomic dysfunction is correlated with postictal hypoxemia. A prolonged impairment of parasympathetic tone might expose a patient to a greater risk of postictal sudden unexpected death. The real-time measurement of parasympathetic tone in patients with epilepsy may be of value to medical staff as an early warning system.
PID Serval
serval:BIB_BA8C242EFA4D
PMID
Date de création
2016-10-11T14:30:06.521Z
Date de création dans IRIS
2025-05-21T04:52:58Z