Abstract
Background
Epilepsy is associated with ictal autonomic dysfunction which may extend into the inter-ictal period. Antiepileptic drugs have often been blamed for cardiac autonomic dysfunction in epilepsy patients. In this study we have investigated cardiac autonomic parameters in order to evaluate autonomic functions of drug-naïve epilepsy patients.
Method
Twenty drugnaïve patients (15 males and 5 females) with epilepsy, and an equal number of age and gender matched controls, were evaluated for short-term resting heart rate variability and conventional cardiovascular autonomic measurements.
Results
The mean age of patients was 29.30 ± 9.80 yrs (17–55 yrs), mean age at seizure onset was 19.70 ± 9.15 yrs (3–40 yrs) and mean length of time since last seizure was 5.60 ± 7.00 days (1–30 days). While there was no difference in the resting heart rate or conventional autonomic test parameters, time domain heart rate variability measurements showed a decreased percentage of R-R intervals of less than 50 ms and root mean square of R-R intervals in patients, when compared to controls. Frequency domain parameters showed a decreased total power (patients: 1,796.58 ± 1,052.45 ms2; controls: 2,934.23 ± 1,767.06 ms2, p = 0.008). Parameters indicative of decreased vagal tone, i.e. decreased high frequency power and increased low to high frequency ratio (patients: 1.69 ± 0.94; controls: 1.14 ± 0.64, p = 0.045), were observed among patients compared to controls.
Conclusion
Subtle but definite cardiac autonomic dysfunction, especially in vagal tone, was identified in drug-naïve, new-onset epilepsy patients. Seizures can cause long-term and often progressive cardiac autonomic dysfunction which may be independent of concomitant antiepileptic drugs.
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References
Ansakorpi H, Korpelainen JT, Huikuri HV, Tolonen U, Myllylä VV, Isojärvi JIT. Heart rate dynamics in refractory and well controlled temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2002; 76: 26–30.
Berilgen MS, Sari T, Bulut S, Mungen B. Effects of epilepsy on autonomic nervous system and respiratory function tests. Epilepsy Behav 2004; 5: 513–516.
Brown ML, Huston PE, Hines HM, Brown GW. Cardiovascular changes associated with electroconvulsive shock in monkeys; cerebral blood flow, blood pressure and cardiac rate measurements before, during and after electroconvulsive shock. Arch Neurol Psychiatry 1953; 69: 609–614.
Camm AJ, Malik M. Task Force of the European Society ofCardiology, the North American Society of Pacing Electrophysiology, Heart Rate Variability Standards of Measurement, Physiological Interpretation, and Clinical Use. Circulation 1996; 93: 1043–1065.
Diehl B, Diehl RR, Stodieck SR, Ringelstein EB. Spontaneous oscillations in cerebral blood flow velocities in middle cerebral arteries in control subjects and patients with epilepsy. Stroke 1997; 28: 2457–2459.
Evrengül H, Tanriverdi H, Dursunoglu D, et al. Time and frequency domain analysis of heart rate variability in patients with epilepsy. Epilepsy Res 2005; 63: 131–139.
Hennessy MJ, Tighe MG, Binnie CD, Nashef L. Sudden withdrawal of carbamazepine increases cardiac sympathetic activity in sleep. Neurology 2001; 57: 1650–1654.
Isojärvi JI, Hanna A, Kalervo S, Uolevi T, Marja R, Vilho VM. Interictal cardiovascular autonomic responses in patients with epilepsy. Epilepsia 1998; 39: 420–426.
Joo EY, Tae WS, Hong SB. Cerebral blood flow abnormality in patients with idiopathic generalized epilepsy. J Neurol 2008; 255:520–525. Lai I, Yang C, Kuo T, Wang Y, Shieh K. Immediate impact of electroconvulsive therapy on cardiac autonomic function in schizophrenia: A preliminary study. Schiz Res 2008; 100: 353–5.
Nashef L, Walker F, Allen P. Apnoea and bradycardia during epileptic seizures: Relation to sudden death in epilepsy. J Neurol Neurosurg Psychiat 1996; 60: 297–300.
Nouri S, Balish M. Epilepsy and the autonomic nervous system. In: Bromfield EB, Talavera F, Cavazos JE, Baker MJ, Lorenzo NY (eds). eMedicine. WebMD. http://www.emedicine.com/neuro/ TOPIC658.HTM [date assessed: Oct 6, 2008]
Novak V, Reeves AL, Novak P, Low PA, Sharbrough FW. Time frequency mapping of RR interval during complex partial seizures of temporal lobe origin. J Auton Nerv Syst 1999; 77: 195–202.
Persson H, Ericson M, Tomson T. Heart rate variability in patients with untreated epilepsy. Seizure 2007; 17: 504–508.
Sathyaprabha TN, Satishchandra P, Netravathi K, Sinha S, Thennarasu K, Raju TR. Cardiac autonomic dysfunctions in chronic refractory epilepsy. Epilepsy Res 2006; 72: 49–56.
Sathyaprabha TN, Satishchandra P, Pradhan C, et al. Modulation of Cardiac Autonomic Balance with Adjuvant Yoga Therapy in Patients with refractory epilepsy. Epilepsy Behav 2008; 12: 245–252.
Thomas S. Epilepsy care in six Indian cities: a multicenter study on management and service. Neurol Sci 2001; 188: 73–77.
Van Buren JM. Some autonomic concomitants of ictal automatism: A study of temporal lobe attacks. Brain 1958; 81: 505–528.
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Mativo, P., Anjum, J., Pradhan, C. et al. Study of cardiac autonomic function in drug-naïve, newly diagnosed epilepsy patients. Epileptic Disord 12, 212–216 (2010). https://doi.org/10.1684/epd.2010.0325
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DOI: https://doi.org/10.1684/epd.2010.0325