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Mason F, Scarabello A, Taruffi L, Pasini E, Calandra-Buonaura G, Vignatelli L, Bisulli F. Heart Rate Variability as a Tool for Seizure Prediction: A Scoping Review. J Clin Med 2024; 13:747. [PMID: 38337440 PMCID: PMC10856437 DOI: 10.3390/jcm13030747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The most critical burden for People with Epilepsy (PwE) is represented by seizures, the unpredictability of which severely impacts quality of life. The design of real-time warning systems that can detect or even predict ictal events would enhance seizure management, leading to high benefits for PwE and their caregivers. In the past, various research works highlighted that seizure onset is anticipated by significant changes in autonomic cardiac control, which can be assessed through heart rate variability (HRV). This manuscript conducted a scoping review of the literature analyzing HRV-based methods for detecting or predicting ictal events. An initial search on the PubMed database returned 402 papers, 72 of which met the inclusion criteria and were included in the review. These results suggest that seizure detection is more accurate in neonatal and pediatric patients due to more significant autonomic modifications during the ictal transitions. In addition, conventional metrics are often incapable of capturing cardiac autonomic variations and should be replaced with more advanced methodologies, considering non-linear HRV features and machine learning tools for processing them. Finally, studies investigating wearable systems for heart monitoring denoted how HRV constitutes an efficient biomarker for seizure detection in patients presenting significant alterations in autonomic cardiac control during ictal events.
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Affiliation(s)
- Federico Mason
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Anna Scarabello
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Lisa Taruffi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Elena Pasini
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Luca Vignatelli
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
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Aimaier G, Qian K, Cao H, Peng W, Zhang Z, Ma J, Ding J, Wang X. Inhibitory Neurons in Nucleus Tractus Solitarius Are Involved in Decrease of Heart Rate Variability and Development of Depression-Like Behaviors in Temporal Lobe Epilepsy. Int J Neuropsychopharmacol 2023; 26:669-679. [PMID: 37417335 PMCID: PMC10586034 DOI: 10.1093/ijnp/pyad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/09/2023] [Accepted: 07/16/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Diminished heart rate variability (HRV) has been observed in epilepsy, especially in epilepsy with depressive disorders. However, the underlying mechanism remains elusive. METHODS We studied HRV, spontaneous recurrent seizures, and depression-like behaviors in different phases of pilocarpine-induced temporal lobe epilepsy (TLE) in mice. Single-cell RNA sequencing analysis was used to identify various nerve cell subsets in TLE mice with and without depression. Differentially expressed gene (DEG) analysis was performed in epilepsy, depression, and HRV central control-related brain areas. RESULTS We found decreased HRV parameters in TLE mice, and alterations were positively correlated with the severity of depression-like behaviors. The severity of depression-like behaviors was correlated with the frequency of spontaneous recurrent seizure. Characteristic expression of mitochondria-related genes was significantly elevated in mice with depression in glial cells, and the enrichment analysis of those DEGs showed an enriched GABAergic synapse pathway in the HRV central control-related brain area. Furthermore, inhibitory neurons in the nucleus tractus solitarius, which is an HRV central control-related brain area, were specifically expressed in TLE mice combined with depression compared with those in mice without depression. A significantly enriched long-term depression pathway in DEGs from inhibitory neurons was found. CONCLUSIONS Our study reported correlations between HRV and epilepsy-depression comorbidity in different phases of TLE. More importantly, we found that HRV central control-related inhibitory neurons are involved in the development of depression in TLE, providing new insights into epilepsy comorbid with depression.
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Affiliation(s)
- Guliqiemu Aimaier
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Neurology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kun Qian
- Department of Information and Intelligence Development, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huateng Cao
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Intelligence Technology, Shanghai, China
| | - Weifeng Peng
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Zhang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Intelligence Technology, Shanghai, China
| | - Jianhua Ma
- Department of Neurology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of The State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
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Kassinopoulos M, Rolandi N, Alphan L, Harper RM, Oliveira J, Scott C, Kozák LR, Guye M, Lemieux L, Diehl B. Brain Connectivity Correlates of Breathing and Cardiac Irregularities in SUDEP: A Resting-State fMRI Study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.19.541412. [PMID: 37293113 PMCID: PMC10245782 DOI: 10.1101/2023.05.19.541412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of premature mortality among people with epilepsy. Evidence from witnessed and monitored SUDEP cases indicate seizure-induced cardiovascular and respiratory failures; yet, the underlying mechanisms remain obscure. SUDEP occurs often during the night and early morning hours, suggesting that sleep or circadian rhythm-induced changes in physiology contribute to the fatal event. Resting-state fMRI studies have found altered functional connectivity between brain structures involved in cardiorespiratory regulation in later SUDEP cases and in individuals at high-risk of SUDEP. However, those connectivity findings have not been related to changes in cardiovascular or respiratory patterns. Here, we compared fMRI patterns of brain connectivity associated with regular and irregular cardiorespiratory rhythms in SUDEP cases with those of living epilepsy patients of varying SUDEP risk, and healthy controls. We analysed resting-state fMRI data from 98 patients with epilepsy (9 who subsequently succumbed to SUDEP, 43 categorized as low SUDEP risk (no tonic-clonic seizures (TCS) in the year preceding the fMRI scan), and 46 as high SUDEP risk (>3 TCS in the year preceding the scan)) and 25 healthy controls. The global signal amplitude (GSA), defined as the moving standard deviation of the fMRI global signal, was used to identify periods with regular ('low state') and irregular ('high state') cardiorespiratory rhythms. Correlation maps were derived from seeds in twelve regions with a key role in autonomic or respiratory regulation, for the low and high states. Following principal component analysis, component weights were compared between the groups. We found widespread alterations in connectivity of precuneus/posterior cingulate cortex in epilepsy compared to controls, in the low state (regular cardiorespiratory activity). In the low state, and to a lesser degree in the high state, reduced anterior insula connectivity (mainly with anterior and posterior cingulate cortex) in epilepsy appeared, relative to healthy controls. For SUDEP cases, the insula connectivity differences were inversely related to the interval between the fMRI scan and death. The findings suggest that anterior insula connectivity measures may provide a biomarker of SUDEP risk. The neural correlates of autonomic brain structures associated with different cardiorespiratory rhythms may shed light on the mechanisms underlying terminal apnea observed in SUDEP.
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Affiliation(s)
- Michalis Kassinopoulos
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Chalfont St. Peter, Buckinghamshire, United Kingdom
| | - Nicolo Rolandi
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Chalfont St. Peter, Buckinghamshire, United Kingdom
| | - Laren Alphan
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ronald M. Harper
- UCLA Brain Research Institute, Los Angeles, CA, United States
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Joana Oliveira
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, UCLH, London, United Kingdom
| | - Catherine Scott
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, UCLH, London, United Kingdom
| | - Lajos R. Kozák
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, CEMEREM, Marseille, France
| | - Louis Lemieux
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Chalfont St. Peter, Buckinghamshire, United Kingdom
| | - Beate Diehl
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Chalfont St. Peter, Buckinghamshire, United Kingdom
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Esmaeili B, Weisholtz D, Tobochnik S, Dworetzky B, Friedman D, Kaffashi F, Cash S, Cha B, Laze J, Reich D, Farooque P, Gholipour T, Singleton M, Loparo K, Koubeissi M, Devinsky O, Lee JW. Association between postictal EEG suppression, postictal autonomic dysfunction, and sudden unexpected death in epilepsy: Evidence from intracranial EEG. Clin Neurophysiol 2023; 146:109-117. [PMID: 36608528 DOI: 10.1016/j.clinph.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The association between postictal electroencephalogram (EEG) suppression (PES), autonomic dysfunction, and Sudden Unexpected Death in Epilepsy (SUDEP) remains poorly understood. We compared PES on simultaneous intracranial and scalp-EEG and evaluated the association of PES with postictal heart rate variability (HRV) and SUDEP outcome. METHODS Convulsive seizures were analyzed in patients with drug-resistant epilepsy at 5 centers. Intracranial PES was quantified using the Hilbert transform. HRV was quantified using root mean square of successive differences of interbeat intervals, low-frequency to high-frequency power ratio, and RR-intervals. RESULTS There were 64 seizures from 63 patients without SUDEP and 11 seizures from 6 SUDEP patients. PES occurred in 99% and 87% of seizures on intracranial-EEG and scalp-EEG, respectively. Mean PES duration in intracranial and scalp-EEG was similar. Intracranial PES was regional (<90% of channels) in 46% of seizures; scalp PES was generalized in all seizures. Generalized PES showed greater decrease in postictal parasympathetic activity than regional PES. PES duration and extent were similar between patients with and without SUDEP. CONCLUSIONS Regional intracranial PES can be present despite scalp-EEG demonstrating generalized or no PES. Postictal autonomic dysfunction correlates with the extent of PES. SIGNIFICANCE Intracranial-EEG demonstrates changes in autonomic regulatory networks not seen on scalp-EEG.
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Affiliation(s)
- Behnaz Esmaeili
- Department of Neurology, University of Washington, Seattle, WA, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Daniel Weisholtz
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Barbara Dworetzky
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Friedman
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Farhad Kaffashi
- Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Sydney Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Brannon Cha
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Juliana Laze
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Dustine Reich
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Pue Farooque
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Taha Gholipour
- Department of Neurology, George Washington University, Washington, DC, USA
| | - Michael Singleton
- Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
| | - Kenneth Loparo
- Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Mohamad Koubeissi
- Department of Neurology, George Washington University, Washington, DC, USA
| | - Orrin Devinsky
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Jong Woo Lee
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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Lamrani Y, Tran TPY, Toffa DH, Robert M, Bérubé AA, Nguyen DK, Bou Assi E. Unexpected cardiorespiratory findings postictally and at rest weeks prior to SUDEP. Front Neurol 2023; 14:1129395. [PMID: 37034071 PMCID: PMC10080096 DOI: 10.3389/fneur.2023.1129395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Mechanisms underlying sudden unexpected death in epilepsy (SUDEP) are unclear, but autonomic disorders are thought to play a critical role. However, those dysfunctions have mainly been reported in the peri-ictal context of generalized tonic-clonic seizures. Here, we explored whether heart rate variability (HRV), heart rate (HR), and breathing rate (BR) changes could be observed perictally during focal seizures with or without impaired awareness as well as interictally to assess the risk of SUDEP. We report the case of a 33-year-old patient with drug-resistant bilateral temporal lobe epilepsy who died at home probably from an unwitnessed nocturnal seizure ("probable SUDEP"). Methods Ictal and interictal HRV as well as postictal cardiorespiratory analyses were conducted to assess autonomic functions and overall SUDEP risk. The SUDEP patient was compared to two living male patients from our local database matched for age, sex, and location of the epileptic focus. Results Interictal HRV analysis showed that all sleep HRV parameters and most awake HRV parameters of the SUDEP patient were significantly lower than those of our two control subjects with bitemporal lobe epilepsy without SUDEP (p < 0.01). In two focal with impaired awareness seizures (FIAS) of the SUDEP patient, increased postictal mean HR and reduced preictal mean high frequency signals (HF), known markers of increased seizure severity in convulsive seizures, were seen postictally. Furthermore, important autonomic instability and hypersensitivity were seen through fluctuations in LF/HF ratio following two seizures of the SUDEP patient, with a rapid transition between sympathetic and parasympathetic activity. In addition, a combination of severe hypopnea (202 s) and bradycardia (10 s), illustrating autonomic dysfunction, was found after one of the SUDEP patient's FIAS. Discussion The unusual cardiorespiratory and HRV patterns found in this case indicated autonomic abnormalities that were possibly predictive of an increased risk of SUDEP. It will be interesting to perform similar analyses in other SUDEP cases to see whether our findings are anecdotal or instead suggestive of reliable biomarkers of high SUDEP risk in focal epilepsy, in particular focal with or without impaired awareness seizures.
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Affiliation(s)
- Yassine Lamrani
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
- *Correspondence: Yassine Lamrani,
| | - Thi Phuoc Yen Tran
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - Dènahin Hinnoutondji Toffa
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Manon Robert
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - Arline-Aude Bérubé
- Division of Neurology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
- Division of Neurology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Elie Bou Assi
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
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Interictal Heart Rate Variability as a Biomarker for Comorbid Depressive Disorders among People with Epilepsy. Brain Sci 2022; 12:brainsci12050671. [PMID: 35625056 PMCID: PMC9139412 DOI: 10.3390/brainsci12050671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 12/10/2022] Open
Abstract
Depressive disorders are common among people with epilepsy (PwE). We here aimed to report an unbiased automatic classification of epilepsy comorbid depressive disorder cases via training a linear support vector machine (SVM) model using the interictal heart rate variability (HRV) data. One hundred and eighty-six subjects participated in this study. Among all participants, we recorded demographic information, epilepsy states and neuropsychiatric features. For each subject, we performed simultaneous electrocardiography and electroencephalography recordings both in wakefulness and non-rapid eye movement (NREM) sleep stage. Using these data, we systematically explored the full parameter space in order to determine the most effective combinations of data to classify the depression status in PwE. PwE with depressive disorders exhibited significant alterations in HRV parameters, including decreased time domain and nonlinear domain values both in wakefulness and NREM sleep stage compared with without depressive disorders and non-epilepsy controls. Interestingly, PwE without depressive disorder showed the same level of HRV values as the non-epilepsy control subjects. The SVM classification model of PwE depression status achieved a higher classification accuracy with the combination of HRV parameters in wakefulness and NREM sleep stage. Furthermore, the receiver operating characteristic (ROC) curve of the SVM classification model showed a satisfying area under the ROC curve (AUC: 0.758). Intriguingly, we found that the HRV measurements during NREM sleep are particularly important for correct classification, suggesting a mechanistic link between the dysregulation of heart rate during sleep and the development of depressive disorders in PwE. Our classification model may provide an objective measurement to assess the depressive status in PwE.
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Abnormal heart rate variability during non-REM sleep and postictal generalized EEG suppression in focal epilepsy. Clin Neurophysiol 2022; 140:40-44. [DOI: 10.1016/j.clinph.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/07/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
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Maruyama S, Jain P, Parbhoo K, Go C, Shibata T, Otsubo H. Prolonged Video-EEG and Heart Rate Variability can Elucidate Autonomic Dysregulation in Infantile Apneic Seizures. Pediatr Neurol 2022; 127:48-55. [PMID: 34959160 DOI: 10.1016/j.pediatrneurol.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/06/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Infantile apneic seizures (IASs) are unexpected life-threatening events. We aimed to determine the utility of prolonged video-electroencephalography (vEEG) and heart rate variability (HRV) in IAS. METHODS The study included seven infants with apneic seizures captured by vEEG, percutaneous oxygen saturation (SpO2), and electrocardiography (ECG). Interictal, preictal, and postictal HRV of patients and N2 sleep HRV of 10 age-matched controls were determined. RESULTS We analyzed seven vEEGs (duration = 17 to 87 hours) of seven patients aged three to 13 months (mean onset age of apneic event = 6.3 months). Fifteen apneic seizures (one to five per infant) were captured. The initial apneic seizure was captured at 7.5 to 76 hours (mean = 36.6 hours) after vEEG initiation. Ictal rhythmic delta/theta/fast waves were seen over temporal (five patients), central (one), and diffuse areas (one). Ictal SpO2 decreased between 1.5% and 90% (mean = 47.9%). Ictal decreased heart rate (HR) (six seizures) and ictal increased HR (14) was detected. Both decreased and increased HR was observed (five). The preictal low-frequency (LF)/high-frequency (HF) ratio was significantly higher than the interictal LF/HF ratio (P = 0.048). Preictal (P = 0.048), and postictal (P = 0.019) root mean square of successive differences (RMSSDs) of patients were lower than the sleep RMSSD of controls. These results indicated dominant sympathetic activity. RMSSD from interictal to preictal periods tended to be higher in IAS with decreased HR than in IAS with increased HR alone (P = 0.066). The postictal RMSSD showed tendency to be higher in IAS with decreased HR than in IAS with increased HR alone (P = 0.088). The decreased HR and increased RMSSD suggested not only sympathetic activity but also escalated parasympathetic activity in IAS. CONCLUSIONS Infants with unexpected apneic events should be monitored with prolonged vEEG, SpO2, and ECG. Abnormal HRV in infants with apneic seizures might indicate additional autonomic dysregulation in IAS.
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Affiliation(s)
- Shinsuke Maruyama
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Puneet Jain
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kaajal Parbhoo
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Takashi Shibata
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Faria MT, Rodrigues S, Campelo M, Dias D, Rego R, Rocha H, Sá F, Tavares-Silva M, Pinto R, Pestana G, Oliveira A, Pereira J, Cunha JPS, Rocha-Gonçalves F, Gonçalves H, Martins E. Does the type of seizure influence heart rate variability changes? Epilepsy Behav 2022; 126:108453. [PMID: 34864377 DOI: 10.1016/j.yebeh.2021.108453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Heart rate variability (HRV), an index of the autonomic cardiac activity, is decreased in patients with epilepsy, and a low HRV is associated with a higher risk of sudden death. Generalized tonic-clonic seizures are one of the most consistent risk factors for SUDEP, but the influence (and relative risk) of each type of seizure on cardiac function is still unknown. Our objective was to assess the impact of the type of seizure (focal to bilateral tonic-clonic seizure - FBTCS - versus non-FBTCS) on periictal HRV, in a group of patients with refractory epilepsy and both types of seizures. METHODS We performed a 48-hour Holter recording on 121 patients consecutively admitted to our Epilepsy Monitoring Unit. We only included patients with both FBTCS and non-FBTCS on the Holter recording and selected the first seizure of each type to analyze. To evaluate HRV parameters (AVNN, SDNN, RMSSD, pNN20, LF, HF, and LF/HF), we chose 5-min epochs pre- and postictally. RESULTS We included 14 patients, with a median age of 36 (min-max, 16-55) years and 64% were female. Thirty-six percent had cardiovascular risk factors, but no previously known cardiac disease. In the preictal period, there were no statistically significant differences in HRV parameters, between FBTCS and non-FBTCS. In the postictal period, AVNN, RMSSD, pNN20, LF, and HF were significantly lower, and LF/HF and HR were significantly higher in FBTCS. From preictal to postictal periods, FBTCS elicited a statistically significant rise in HR and LF/HF, and a statistically significant fall in AVNN, RMSSD, pNN20, and HF. Non-FBTCS only caused statistically significant changes in HR (decrease) and AVNN (increase). SIGNIFICANCE/CONCLUSION This work emphasizes the greater effect of FBTCS in autonomic cardiac function in patients with refractory epilepsy, compared to other types of seizures, with a significant reduction in vagal tonus, which may be associated with an increased risk of SUDEP.
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Affiliation(s)
- Maria Teresa Faria
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
| | - Susana Rodrigues
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal
| | - Manuel Campelo
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Duarte Dias
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal
| | - Ricardo Rego
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Helena Rocha
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Francisca Sá
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Marta Tavares-Silva
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Gonçalo Pestana
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Ana Oliveira
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Jorge Pereira
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - João Paulo Silva Cunha
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Hernâni Gonçalves
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Faculty of Medicine, University of Porto, Portugal
| | - Elisabete Martins
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
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10
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Nielsen JM, Rades D, Kjaer TW. Wearable electroencephalography for ultra-long-term seizure monitoring: a systematic review and future prospects. Expert Rev Med Devices 2021; 18:57-67. [PMID: 34836477 DOI: 10.1080/17434440.2021.2012152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION : Wearable electroencephalography (EEG) for objective seizure counting might transform the clinical management of epilepsy. Non-EEG modalities have been validated for the detection of convulsive seizures, but there is still an unmet need for the detection of non-convulsive seizures. AREAS COVERED : The main objective of this systematic review was to explore the current status on wearable surface- and subcutaneous EEG for long-term seizure monitoring in epilepsy. We included 17 studies and evaluated the progress on the field, including device specifications, intended populations, and main results on the published studies including diagnostic accuracy measures. Furthermore, we examine the hurdles for widespread clinical implementation. This systematic review and expert opinion both consults the PRISMA guidelines and reflects on the future perspectives of this emerging field. EXPERT OPINION : Wearable EEG for long-term seizure monitoring is an emerging field, with plenty of proposed devices and proof-of-concept clinical validation studies. The possible implications of these devices are immense including objective seizure counting and possibly forecasting. However, the true clinical value of the devices, including effects on patient important outcomes and clinical decision making is yet to be unveiled and large-scale clinical validation trials are called for.
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Affiliation(s)
- Jonas Munch Nielsen
- Department of Neurology, Zealand University Hospital, Region Sjælland. Vestermarksvej 11, 4000 Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Troels Wesenberg Kjaer
- Department of Neurology, Zealand University Hospital, Region Sjælland. Vestermarksvej 11, 4000 Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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11
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Glasstetter M, Böttcher S, Zabler N, Epitashvili N, Dümpelmann M, Richardson MP, Schulze-Bonhage A. Identification of Ictal Tachycardia in Focal Motor- and Non-Motor Seizures by Means of a Wearable PPG Sensor. SENSORS (BASEL, SWITZERLAND) 2021; 21:6017. [PMID: 34577222 PMCID: PMC8470979 DOI: 10.3390/s21186017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
Photoplethysmography (PPG) as an additional biosignal for a seizure detector has been underutilized so far, which is possibly due to its susceptibility to motion artifacts. We investigated 62 focal seizures from 28 patients with electrocardiography-based evidence of ictal tachycardia (IT). Seizures were divided into subgroups: those without epileptic movements and those with epileptic movements not affecting and affecting the extremities. PPG-based heart rate (HR) derived from a wrist-worn device was calculated for sections with high signal quality, which were identified using spectral entropy. Overall, IT based on PPG was identified in 37 of 62 (60%) seizures (9/19, 7/8, and 21/35 in the three groups, respectively) and could be found prior to the onset of epileptic movements affecting the extremities in 14/21 seizures. In 30/37 seizures, PPG-based IT was in good temporal agreement (<10 s) with ECG-based IT, with an average delay of 5.0 s relative to EEG onset. In summary, we observed that the identification of IT by means of a wearable PPG sensor is possible not only for non-motor seizures but also in motor seizures, which is due to the early manifestation of IT in a relevant subset of focal seizures. However, both spontaneous and epileptic movements can impair PPG-based seizure detection.
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Affiliation(s)
- Martin Glasstetter
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Sebastian Böttcher
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Nicolas Zabler
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Nino Epitashvili
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Matthias Dümpelmann
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Mark P. Richardson
- Division of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience King’s College London, London SE5 9RT, UK;
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
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12
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Kassinopoulos M, Harper RM, Guye M, Lemieux L, Diehl B. Altered Relationship Between Heart Rate Variability and fMRI-Based Functional Connectivity in People With Epilepsy. Front Neurol 2021; 12:671890. [PMID: 34177777 PMCID: PMC8223068 DOI: 10.3389/fneur.2021.671890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Disruptions in central autonomic processes in people with epilepsy have been studied through evaluation of heart rate variability (HRV). Decreased HRV appears in epilepsy compared to healthy controls, suggesting a shift in autonomic balance toward sympathetic dominance; recent studies have associated HRV changes with seizure severity and outcome of interventions. However, the processes underlying these autonomic changes remain unclear. We examined the nature of these changes by assessing alterations in whole-brain functional connectivity, and relating those alterations to HRV. Methods: We examined regional brain activity and functional organization in 28 drug-resistant epilepsy patients and 16 healthy controls using resting-state functional magnetic resonance imaging (fMRI). We employed an HRV state-dependent functional connectivity (FC) framework with low and high HRV states derived from the following four cardiac-related variables: 1. RR interval, 2. root mean square of successive differences (RMSSD), 4. low-frequency HRV (0.04-0.15 Hz; LF-HRV) and high-frequency HRV (0.15-0.40 Hz; HF-HRV). The effect of group (epilepsy vs. controls), HRV state (low vs. high) and the interactions of group and state were assessed using a mixed analysis of variance (ANOVA). We assessed FC within and between 7 large-scale functional networks consisting of cortical regions and 4 subcortical networks, the amygdala, hippocampus, basal ganglia and thalamus networks. Results: Consistent with previous studies, decreased RR interval (increased heart rate) and decreased HF-HRV appeared in people with epilepsy compared to healthy controls. For both groups, fluctuations in heart rate were positively correlated with BOLD activity in bilateral thalamus and regions of the cerebellum, and negatively correlated with BOLD activity in the insula, putamen, superior temporal gyrus and inferior frontal gyrus. Connectivity strength in patients between right thalamus and ventral attention network (mainly insula) increased in the high LF-HRV state compared to low LF-HRV; the opposite trend appeared in healthy controls. A similar pattern emerged for connectivity between the thalamus and basal ganglia. Conclusion: The findings suggest that resting connectivity patterns between the thalamus and other structures underlying HRV expression are modified in people with drug-resistant epilepsy compared to healthy controls.
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Affiliation(s)
- Michalis Kassinopoulos
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Buckinghamshire, United Kingdom
| | - Ronald M. Harper
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Buckinghamshire, United Kingdom
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Buckinghamshire, United Kingdom
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13
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Costagliola G, Orsini A, Coll M, Brugada R, Parisi P, Striano P. The brain-heart interaction in epilepsy: implications for diagnosis, therapy, and SUDEP prevention. Ann Clin Transl Neurol 2021; 8:1557-1568. [PMID: 34047488 PMCID: PMC8283165 DOI: 10.1002/acn3.51382] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
The influence of the central nervous system and autonomic system on cardiac activity is being intensively studied, as it contributes to the high rate of cardiologic comorbidities observed in people with epilepsy. Indeed, neuroanatomic connections between the brain and the heart provide links that allow cardiac arrhythmias to occur in response to brain activation, have been shown to produce arrhythmia both experimentally and clinically. Moreover, seizures may induce a variety of transient cardiac effects, which include changes in heart rate, heart rate variability, arrhythmias, asystole, and other ECG abnormalities, and can trigger the development of Takotsubo syndrome. People with epilepsy are at a higher risk of death than the general population, and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Although the cause of SUDEP is still unknown, cardiac abnormalities during and between seizures could play a significant role in its pathogenesis, as highlighted by studies on animal models of SUDEP and registration of SUDEP events. Recently, genetic mutations in genes co-expressed in the heart and brain, which may result in epilepsy and cardiac comorbidity/increased risk for SUDEP, have been described. Recognition and a better understanding of brain-heart interactions, together with new advances in sequencing techniques, may provide new insights into future novel therapies and help in the prevention of cardiac dysfunction and sudden death in epileptic individuals.
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Affiliation(s)
- Giorgio Costagliola
- Pediatric Clinic, Santa Chiara's University Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Orsini
- Pediatric Clinic, Santa Chiara's University Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Monica Coll
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain.,Medical Science Department, School of Medicine, University of Girona, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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14
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Yang Z, Cheng TY, Deng J, Wang Z, Qin X, Fang X, Yuan Y, Hao H, Jiang Y, Liao J, Yin F, Chen Y, Zou L, Li B, Gao Y, Shu X, Huang S, Gao F, Liang J, Li L. Impairment of Cardiac Autonomic Nerve Function in Pre-school Children With Intractable Epilepsy. Front Neurol 2021; 12:632370. [PMID: 34248813 PMCID: PMC8267887 DOI: 10.3389/fneur.2021.632370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/10/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: Intractable epilepsy and uncontrolled seizures could affect cardiac function and the autonomic nerve system with a negative impact on children's growth. The aim of this study was to investigate the variability and complexity of cardiac autonomic function in pre-school children with pediatric intractable epilepsy (PIE). Methods: Twenty four-hour Holter electrocardiograms (ECGs) from 93 patients and 46 healthy control subjects aged 3-6 years were analyzed by the methods of traditional heart rate variability (HRV), multiscale entropy (MSE), and Kurths-Wessel symbolization entropy (KWSE). Receiver operating characteristic (ROC) curve analysis was used to estimate the overall discrimination ability. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) models were also analyzed. Results: Pre-school children with PIE had significantly lower HRV measurements than healthy controls in time (Mean_RR, SDRR, RMSSD, pNN50) and frequency (VLF, LF, HF, LF/HF, TP) domains. For the MSE analysis, area 1_5 in awake state was lower, and areas 6_15 and 6_20 in sleep state were higher in PIE with a significant statistical difference. KWSE in the PIE group was also inferior to that in healthy controls. In ROC curve analysis, pNN50 had the greatest discriminatory power for PIE. Based on both NRI and IDI models, the combination of MSE indices (wake: area1_5 and sleep: area6_20) and KWSE (m = 2, τ = 1, α = 0.16) with traditional HRV measures had greater discriminatory power than any of the single HRV measures. Significance: Impaired HRV and complexity were found in pre-school children with PIE. HRV, MSE, and KWSE could discriminate patients with PIE from subjects with normal cardiac complexity. These findings suggested that the MSE and KWSE methods may be helpful for assessing and understanding heart rate dynamics in younger children with epilepsy.
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Affiliation(s)
- Zhao Yang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Tung-Yang Cheng
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Jin Deng
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Zhiyan Wang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Xiaoya Qin
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Xi Fang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Yuan Yuan
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Hongwei Hao
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Yuwu Jiang
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
- Department of Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital of Central South University, Changsha, China
- Hunan Intellectual and Developmental Disabilities Research Center of Children, Changsha, China
| | - Yanhui Chen
- Division of Pediatric Neurology, Pediatrics Department, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Epilepsy Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liping Zou
- Department of Pediatric, The People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Baomin Li
- Pediatics Department, Qilu Hospital of Shandong University, Jinan, China
| | - Yuxing Gao
- Division of Pediatrics Neurology, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaomei Shu
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | - Shaoping Huang
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Gao
- Department of Neurology, The Children's Hospital, ZheJiang University School of Medicine, Hangzhou, China
| | - Jianmin Liang
- Department of Pediatric Neurology, First Bethune Hospital, Jilin University, Changchun, China
- Research Center of Neuroscience, First Bethune Hospital, Jilin University, Changchun, China
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
- Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China
- Institute of Human-Machine, School of Aerospace Engineering, Tsinghua University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
- *Correspondence: Luming Li
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15
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Ryvlin P, Beniczky S. Seizure detection and mobile health devices in epilepsy: Recent developments and future perspectives. Epilepsia 2020; 61 Suppl 1:S1-S2. [PMID: 33098105 DOI: 10.1111/epi.16702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital and Danish Epilepsy Center, Dianalund, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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16
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Beniczky S, Arbune AA, Jeppesen J, Ryvlin P. Biomarkers of seizure severity derived from wearable devices. Epilepsia 2020; 61 Suppl 1:S61-S66. [PMID: 32519759 DOI: 10.1111/epi.16492] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022]
Abstract
Besides triggering alarms, wearable seizure detection devices record a variety of biosignals that represent biomarkers of seizure severity. There is a need for automated seizure characterization, to identify high-risk seizures. Wearable devices can automatically identify seizure types with the highest associated morbidity and mortality (generalized tonic-clonic seizures), quantify their duration and frequency, and provide data on postictal position and immobility, autonomic changes derived from electrocardiography/heart rate variability, electrodermal activity, respiration, and oxygen saturation. In this review, we summarize how these biosignals reflect seizure severity, and how they can be monitored in the ambulatory outpatient setting using wearable devices. Multimodal recording of these biosignals will provide valuable information for individual risk assessment, as well as insights into the mechanisms and prevention of sudden unexpected death in epilepsy.
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Affiliation(s)
- Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anca A Arbune
- Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark.,Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Jesper Jeppesen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaud University Hospital Center, Lausanne, Switzerland
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