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Cerebral autoregulation improves in epilepsy patients after temporal lobe surgery

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Abstract.

Patients with temporal lobe epilepsy (TLE) often show increased cardiovascular sympathetic modulation during the interictal period, that decreases after epilepsy surgery. In this study, we evaluated whether temporal lobectomy changes autonomic modulation of cerebral blood flow velocity (CBFV) and cerebral autoregulation. We studied 16 TLE patients 3–4 months before and after surgery. We monitored heart rate (HR), blood pressure (BP), respiration, transcutaneous oxygen saturation (sat-O2), end-expiratory carbon dioxide partial pressure (pCO2) and middle cerebral artery CBFV. Spectral analysis was used to determine sympathetic and parasympathetic modulation of HR, BP and CBFV as powers of signal oscillations in the low frequency (LF) ranges from 0.04–0.15Hz (LF-power) and in the high frequency ranges from (HF) 0.15–0.5Hz (HF-power). LF-transfer function gain and phase shift between BP and CBFV were calculated as parameters of cerebral autoregulation. After surgery, HR, BPmean, CBFVmean, respiration, sat-O2, pCO2 and HF powers remained unchanged. LF-powers of HR, BP, CBFV and LF-transfer function gain had decreased while the phase angle had increased (p<0.05). The reduction of LF powers and LF-gain and the higher phase angle showed reduced sympathetic modulation and improved cerebral autoregulation. The enhanced cerebrovascular stability after surgery may improve autonomic balance in epilepsy patients.

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Authors and Affiliations

  1. Dept. of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany

    Matthias Dütsch & Harald Marthol

  2. Dept. of Neurology, New York University, New York (NY), USA

    Orrin Devinsky & Max J. Hilz M. D.

  3. Dept. of Neurosurgery, New York University, New York (NY), USA

    Werner Doyle

  4. New York University, School of Medicine, Dept. of Neurology, 560, First Avenue, NB 7 W 11, New York (NY), 10016, USA

    Max J. Hilz M. D.

Authors
  1. Matthias Dütsch
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  2. Orrin Devinsky
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  3. Werner Doyle
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  4. Harald Marthol
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  5. Max J. Hilz M. D.
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Dütsch, M., Devinsky, O., Doyle, W. et al. Cerebral autoregulation improves in epilepsy patients after temporal lobe surgery. J Neurol 251, 1190–1197 (2004). https://doi.org/10.1007/s00415-004-0501-5

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  • DOI: https://doi.org/10.1007/s00415-004-0501-5

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