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Sammito S, Thielmann B, Böckelmann I. Update: factors influencing heart rate variability-a narrative review. Front Physiol 2024; 15:1430458. [PMID: 39165281 PMCID: PMC11333334 DOI: 10.3389/fphys.2024.1430458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
Objective Heart rate variability (HRV) is an important non-invasive marker for the assessment of an organism's autonomic physiological regulatory pathways. Lower HRV has been shown to correlate with increased mortality. HRV is influenced by various factors or diseases. The aim of this narrative review is to describe the current state of knowledge on factors influencing HRV and their significance for interpretation. Methods The narrative review only included reviews, meta-analyses, and cohort studies which were published until 2021. HRV confounders were grouped into four categories (non-influenceable physiological factors, diseases, influenceable lifestyle factors and external factors). Results The review found that HRV was decreased not only in non-influenceable physiological factors (e.g., age, gender, ethnicity) but also in connection with various number of acute and chronic diseases (e.g., psychiatric diseases, myocardial infarction, heart failure), influenceable lifestyle factors (e.g., alcohol abuse, overweight, physical activity), and external factors (e.g., heat, noise, shift work, harmful- and hazardous substances). Conclusion In order to improve the quality of HRV studies and to ensure accurate interpretation, it is recommended that confounders be taken into account in future diagnostic measurements or measurements in the workplace (e.g., as part of health promotion measures) in order to counteract data bias.
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Affiliation(s)
- Stefan Sammito
- German Air Force Centre of Aerospace Medicine, Cologne, Germany
- Occupational Medicine, Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Beatrice Thielmann
- Occupational Medicine, Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Irina Böckelmann
- Occupational Medicine, Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany
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2
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Verrier RL, Schachter SC. The Epileptic Heart Syndrome: Epidemiology, pathophysiology and clinical detection. Epilepsy Behav Rep 2024; 27:100696. [PMID: 39184194 PMCID: PMC11342885 DOI: 10.1016/j.ebr.2024.100696] [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: 05/14/2024] [Revised: 07/18/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024] Open
Abstract
Population studies report elevated incidence of cardiovascular events in patients with chronic epilepsy. Multiple pathophysiologic processes have been implicated, including accelerated atherosclerosis, myocardial infarction, altered autonomic tone, heart failure, atrial and ventricular arrhythmias, and hyperlipidemia. These deleterious influences on the cardiovascular system have been attributed to seizure-induced surges in catecholamines and hypoxemic damage to the heart and coronary vasculature. Certain antiseizure medications can accelerate heart disease through enzyme-inducing increases in plasma lipids and/or increasing risk for life-threatening ventricular arrhythmias as a result of sodium channel blockade. In this review, we propose that this suite of pathophysiologic processes constitutes "The Epileptic Heart Syndrome." We further propose that this condition can be diagnosed using standard electrocardiography, echocardiography, and lipid panels. The ultimate goal of this syndromic approach is to evaluate cardiac risk in patients with chronic epilepsy and to promote improved diagnostic strategies to reduce premature cardiac death.
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Affiliation(s)
- Richard L. Verrier
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Steven C. Schachter
- Departments of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
- Department of Neurology, Massachusetts General Hospital, 125 Nashua Street, Suite #324, Boston, MA 02114, United States
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Stoupi NA, Weijs ML, Imbach L, Lenggenhager B. Heartbeat-evoked potentials following voluntary hyperventilation in epilepsy patients: respiratory influences on cardiac interoception. Front Neurosci 2024; 18:1391437. [PMID: 39035777 PMCID: PMC11259972 DOI: 10.3389/fnins.2024.1391437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/12/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Current evidence indicates a modulating role of respiratory processes in cardiac interoception, yet whether altered breathing patterns influence heartbeat-evoked potentials (HEP) remains inconclusive. Methods Here, we examined the effects of voluntary hyperventilation (VH) as part of a clinical routine examination on scalp-recorded HEPs in epilepsy patients (N = 80). Results Using cluster-based permutation analyses, HEP amplitudes were compared across pre-VH and post-VH conditions within young and elderly subgroups, as well as for the total sample. No differences in the HEP were detected for younger participants or across the full sample, while an increased late HEP during pre-VH compared to post-VH was fond in the senior group, denoting decreased cardiac interoceptive processing after hyperventilation. Discussion The present study, thus, provides initial evidence of breathing-related HEP modulations in elderly epilepsy patients, emphasizing the potential of HEP as an interoceptive neural marker that could partially extend to the representation of pulmonary signaling. We speculate that aberrant CO2-chemosensing, coupled with disturbances in autonomic regulation, might constitute the underlying pathophysiological mechanism behind the obtained effect. Available databases involving patient records of routine VH assessment may constitute a valuable asset in disentangling the interplay of cardiac and ventilatory interoceptive information in various patient groups, providing thorough clinical data to parse, as well as increased statistical power and estimates of effects with higher precision through large-scale studies.
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Affiliation(s)
- Niovi A Stoupi
- Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Marieke L Weijs
- Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Lukas Imbach
- Department of Neurology, University Hospital of Zurich, Zürich, Switzerland
- Swiss Epilepsy Center, Klinik Lengg, Zürich, Switzerland
- Zurich Neuroscience Center, University of Zurich and ETH Zurich, Zürich, Switzerland
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Schmidt C. The potential of infra-low frequency neurofeedback training in peak performance: The first double-blinded placebo-controlled longitudinal study in healthy adults. J Psychiatr Res 2024; 175:280-286. [PMID: 38759495 DOI: 10.1016/j.jpsychires.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
Infra-low frequency neurofeedback training (ILF-NFT) has shown promise in addressing cognitive and affective distress symptoms across a range of psychiatric disorders. This study tested ILF-NFT's effects in a double-blinded, placebo-controlled longitudinal context in healthy psychology students. Across five weeks, forty-two healthy psychology students (aged 18-35) were randomly allocated into two groups, receiving ten sessions of 30 minutes of active and sham ILF-NFT. Dependent variables were measured before, following, and two months after the intervention and were comprised of: heartrate variability assessments as a measure of stress resilience; digit span, n-back, trail making and go-no-go task measures of executive functioning performance; and SCL-90-R, WHOQOL-Bref, and peak performance measures of subjective self-report. Statistical analysis was performed using an ANCOVA and compared across groups correcting for baseline differences and multiple comparisons. ANCOVA analyses revealed no significant differences across active and placebo groups in any dependent variables, when correcting for multiple comparisons. Thus, the remaining analyses focused on questionnaire correlations. Here, significant correlations were observed between the novel peak performance questionnaire with the SCL-90-R and WHOQOL-Bref, confirming its construct and retest validity. Despite several methodological limitations, including a potential type-2 error, this study highlights limited effects of ILF-NFT in healthy volunteers. Future research should thus focus on clinically driven experimental designs to explore ILF-NFT's potential in psychiatric contexts. Further research utilization of the novel peak performance questionnaire is recommended for measures of peak performance.
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Affiliation(s)
- Casper Schmidt
- Department of Communication and Psychology, Aalborg University, Rendsburggade 14, 9000, Aalborg, Denmark.
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5
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van den Bongard F, Gowik JK, Coenen J, Jakobsmeyer R, Reinsberger C. Exercise-induced central and peripheral sympathetic activity in a community-based group of epilepsy patients differ from healthy controls. Exp Brain Res 2024; 242:1301-1310. [PMID: 38551692 PMCID: PMC11108887 DOI: 10.1007/s00221-024-06792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/22/2024] [Indexed: 05/23/2024]
Abstract
Ictal and interictal activity within the autonomic nervous system is characterized by a sympathetic overshoot in people with epilepsy. This autonomic dysfunction is assumed to be driven by alterations in the central autonomic network. In this study, exercise-induced changes of the interrelation of central and peripheral autonomic activity in patients with epilepsy was assessed. 21 patients with epilepsy (16 seizure-free), and 21 healthy matched controls performed an exhaustive bicycle ergometer test. Immediately before and after the exercise test, resting state electroencephalography measurements (Brain Products GmbH, 128-channel actiCHamp) of 5 min were carried out to investigate functional connectivity assessed by phase locking value in source space for whole brain, central autonomic network and visual network. Additionally, 1-lead ECG (Brain products GmbH) was performed to analyze parasympathetic (root mean square of successive differences (RMSSD) of the heart rate variability) and sympathetic activity (electrodermal activity (meanEDA)). MeanEDA increased (p < 0.001) and RMSSD decreased (p < 0.001) from pre to post-exercise in both groups. Correlation coefficients of meanEDA and central autonomic network functional connectivity differed significantly between the groups (p = 0.004) after exercise. Both patients with epilepsy and normal control subjects revealed the expected physiological peripheral autonomic responses to acute exhaustive exercise, but alterations of the correlation between central autonomic and peripheral sympathetic activity may indicate a different sympathetic reactivity after exercise in patients with epilepsy. The clinical relevance of this finding and its modulators (seizures, anti-seizure medication, etc.) still needs to be elucidated.
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Affiliation(s)
| | - Julia Kristin Gowik
- Institute of Sports Medicine, Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany
| | - Jessica Coenen
- Institute of Sports Medicine, Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany
| | - Rasmus Jakobsmeyer
- Institute of Sports Medicine, Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany.
- Division of Sports Neurology & Neurosciences, Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
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Sammito S, Thielmann B, Klussmann A, Deußen A, Braumann KM, Böckelmann I. Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science. J Occup Med Toxicol 2024; 19:15. [PMID: 38741189 DOI: 10.1186/s12995-024-00414-9] [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: 12/10/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
This updated guideline replaces the "Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science" first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline.This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.
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Affiliation(s)
- Stefan Sammito
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- German Air Force Centre of Aerospace Medicine, Experimental Aerospace Medicine Research, Flughafenstraße 1, Cologne, 51147, Germany.
| | - Beatrice Thielmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Andre Klussmann
- Competence Centre Health (CCG), Department Health Sciences, University of Applied Sciences (HAW) Hamburg, Hamburg, Germany
| | - Andreas Deußen
- Department of Physiology, Medical Faculty, TU Dresden, Dresden, Germany
| | | | - Irina Böckelmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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7
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Aschner A, Keller A, Williams A, Whitney R, Cunningham K, Hamilton RM, Pollanen M, Donner E. Cardiac arrhythmia and epilepsy genetic variants in sudden unexpected death in epilepsy. Front Neurol 2024; 15:1386730. [PMID: 38756210 PMCID: PMC11097959 DOI: 10.3389/fneur.2024.1386730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/29/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Sudden Unexpected Death in Epilepsy (SUDEP) is the leading epilepsy-related cause of death, affecting approximately 1 per 1,000 individuals with epilepsy per year. Genetic variants that affect autonomic function, such as genes associated with cardiac arrhythmias, may predispose people with epilepsy to greater risk of both sudden cardiac death and SUDEP. Advances in next generation sequencing allow for the exploration of gene variants as potential biomarkers. Methods Genetic testing for the presence of cardiac arrhythmia and epilepsy gene variants was performed via genetic panels in 39 cases of SUDEP identified via autopsy by the Ontario Forensic Pathology Service. Variants were summarized by in-silico evidence for pathogenicity from 4 algorithms (SIFT, PolyPhen-2, PROVEAN, Mutation Taster) and allele frequencies in the general population (GnomAD). A maximum credible population allele frequency of 0.00004 was calculated based on epilepsy prevalence and SUDEP incidence to assess whether a variant was compatible with a pathogenic interpretation. Results Median age at the time of death was 33.3 years (range: 2, 60). Fifty-nine percent (n=23) were male. Gene panels detected 62 unique variants in 45 genes: 19 on the arrhythmia panel and 26 on the epilepsy panel. At least one variant was identified in 28 (72%) of decedents. Missense mutations comprised 57 (92%) of the observed variants. At least three in silico models predicted 12 (46%) cardiac arrhythmia panel missense variants and 20 (65%) epilepsy panel missense variants were pathogenic. Population allele frequencies were <0.00004 for 11 (42%) of the cardiac variants and 10 (32%) of the epilepsy variants. Together, these metrics identified 13 SUDEP variants of interest. Discussion Nearly three-quarters of decedents in this SUDEP cohort carried variants in comprehensive epilepsy or cardiac arrhythmia gene panels, with more than a third having variants in both panels. The proportion of decedents with cardiac variants aligns with recent studies of the disproportionate cardiac burden the epilepsy community faces compared to the general population and suggests a possible cardiac contribution to epilepsy mortality. These results identified 13 priority targets for future functional studies of these genes potential role in sudden death and demonstrates the necessity for further exploration of potential genetic contributions to SUDEP.
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Affiliation(s)
- Amir Aschner
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anne Keller
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Andrew Williams
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robyn Whitney
- McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada
| | - Kris Cunningham
- Department of Pathology and Molecular Medicine, School of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Robert M. Hamilton
- Division of Cardiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michael Pollanen
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Donner
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Loureiro Fialho G, Miotto R, Tatsch Cavagnollo M, Murilo Melo H, Wolf P, Walz R, Lin K. The epileptic heart: Cardiac comorbidities and complications of epilepsy. Atrial and ventricular structure and function by echocardiography in individuals with epilepsy - From clinical implications to individualized assessment. Epilepsy Behav Rep 2024; 26:100668. [PMID: 38699061 PMCID: PMC11063386 DOI: 10.1016/j.ebr.2024.100668] [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: 03/06/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
Epilepsy is an increasing global neurological health issue. Recently, epidemiological and mechanistic studies have raised concern about cardiac involvement in individuals with epilepsy. This has resulted in the "epileptic heart" concept. Epidemiological data linking epilepsy to cardiovascular disease indicate an increased risk for ventricular and atrial arrhythmias, myocardial infarction, heart failure, and sudden death among individuals with epilepsy. Pathways of this interaction comprise increased prevalence of traditional cardiac risk factors, genetic abnormalities, altered brain circuitry with autonomic imbalance, and antiseizure medications with enzyme-inducing and ionic channel-blocking proprieties. Pathophysiological findings in the atria and ventricles of patients with epilepsy are discussed. Echocardiographic findings and future applications of this tool are reviewed. A risk stratification model and future studies on cardiac risk assessment in individuals with epilepsy are proposed.
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Affiliation(s)
- Guilherme Loureiro Fialho
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Ramsés Miotto
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Márcia Tatsch Cavagnollo
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Hiago Murilo Melo
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Peter Wolf
- Danish Epilepsy Centre, Dianalund, Denmark
| | - Roger Walz
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
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Gaertner ML, Mintzer S, DeGiorgio CM. Increased cardiovascular risk in epilepsy. Front Neurol 2024; 15:1339276. [PMID: 38633529 PMCID: PMC11021572 DOI: 10.3389/fneur.2024.1339276] [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: 11/15/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Epilepsy is associated with increased mortality. Cardiovascular disease confers a significant portion of this increased risk. Recently there is increased interest in the burden of cardiovascular mortality in people with epilepsy. This review discusses the most common cardiovascular risk factors and their association with epilepsy including obesity, diabetes mellitus, and hyperlipidemia. Hyperlipidemia related to the use of enzyme inducing anti-seizure medications is also discussed as a topic that is of particular importance to prescribers that have patients with comorbid cardiovascular risk and epilepsy. Heart rate variability (HRV) and its association with SUDEP is discussed as well as a contributor to vascular risk. Finally, the authors discuss a potential role for neurologists who treat epilepsy to engage closer with their patient's cardiovascular risk factors using available tools such as a the ASCVD score calculator to determine the overall risk of mortality, as well as acting upon this information to guide treatment approaches integrating the information provided in this review.
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Affiliation(s)
- Mark L. Gaertner
- Department of Neurology, David Geffen-UCLA School of Medicine, Los Angeles, CA, United States
- Olive View-UCLA Medical Center, Los Angeles, CA, United States
| | - Scott Mintzer
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Christopher M. DeGiorgio
- Department of Neurology, David Geffen-UCLA School of Medicine, Los Angeles, CA, United States
- Olive View-UCLA Medical Center, Los Angeles, CA, United States
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10
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Hamed SA, El Hadad AF, Aladawy MA. The effect of epilepsy and antiseizure medications on cardiac autonomic functions in children with epilepsy. Expert Rev Clin Pharmacol 2024; 17:393-401. [PMID: 38349326 DOI: 10.1080/17512433.2024.2318469] [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: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Autonomic manifestations have been frequently studied in adults with epilepsy. Here, we evaluated cardiac autonomic (ANS) functions in children with epilepsy in the interictal period and determined the risks for their dysfunctions. RESEARCH DESIGN AND METHODS This study included 60 patients (boys = 25; girls = 35 age: 14.53 ± 2.54 yrs) and 25 controls. Patients were well-controlled on antiseizure medications (ASMs). The battery of testing included measuring resting heart rate (HR) and blood pressure (BP), 30:15 ratio, HR variability (HRV) response to deep breathing, Valsalva ratio and BP changes in response to standing, isometric exercise and cold. RESULTS Dizziness was reported in 25%. Autonomic dysfunctions were found in 45% (n = 27). Manifestations included high frequencies of abnormal 30:15 ratio (22%), HRV responses to deep breathing (45%), Valsalava ratio (45%), and BP responses to standing (35%), isometric exercise (27%) and cold (27%), indicating parasympathetic and sympathetic hypofunctions. There were positive correlations between parasympathetic and sympathetic dysfunctions. Logistic analysis showed that the durations of epilepsy and ASMs therapy were associated with ANS dysfunctions [95% CI: 0.895-4.719, p = 0.004]. CONCLUSIONS Parasympathetic and sympathetic autonomic hypofunctions are common in children with epilepsy. This could be due to the depressant effect of sodium channel blocker ASMs on central and/or cardiac autonomic systems.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Ali Farrag El Hadad
- Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut, Egypt
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Behbahani S, Jafarnia Dabanloo N, Nasrabadi AM, Dourado A. Epileptic seizure prediction based on features extracted from lagged Poincaré plots. Int J Neurosci 2024; 134:381-397. [PMID: 35892226 DOI: 10.1080/00207454.2022.2106435] [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: 06/24/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The present work proposes a new epileptic seizure prediction method based on lagged Poincaré plot analysis of heart rate (HR). METHODS In this article, the Poincaré plots with six different lags (1-6) were constructed for four episodes of heart rate variability (HRV) before the seizures. Moreover, two features were extracted based on lagged Poincare plots, which include the angle between the time series and the ellipse density fitted to the RR points. RESULTS The proposed method was applied to 16 epileptic patients with 170 seizures. The results included sensitivity of 80.42% for the angle feature and 75.19% for the density feature. The false-positive rate was 0.15/Hr, which indicates that the system has superiority over the random predictor. CONCLUSION The proposed HRV-based epileptic seizure prediction method has the potential to be used in daily life because HR can be measured easily by using a wearable sensor.
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Affiliation(s)
- Soroor Behbahani
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia
| | - Nader Jafarnia Dabanloo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Antonio Dourado
- Center for Informatics and Systems (CISUC), Department of Informatics Engineering, University of Coimbra, Coimbra, Portugal
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Rana M, Steenari M, Shrey D. Hyperventilation and Seizures: Not a New Sense: A Literature Review. Neuropediatrics 2023; 54:359-364. [PMID: 37813123 DOI: 10.1055/s-0043-1774808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Hyperventilation and seizures have a long association in the clinical literature and were known to have a relationship long before the electroencephalogram (EEG) was used to record changes in brain activity. As the use of EEG recording progressed, hyperventilation was the first activation method used to assist with diagnosis of epilepsy. Along with slowing of brain activity, hyperventilation can activate epileptiform spiking activity in patients with epilepsy. Currently, hyperventilation is used in standard practice to assist with the diagnosis of epilepsy during EEG recording. Hyperventilation activates epileptiform spiking activity more often than seizures but can trigger clinical seizures in up to 50% of patients with generalized epilepsy. It is more likely to trigger events in children with absence seizures than adults, and it acts as a trigger in patients with focal epilepsy far less often. However, while some clinicians suggest that its diagnostic value is limited, especially in adults with focal epilepsies, others suggest that it is simple, safe, and an important diagnostic tool, even in these patients. This review presents the history of hyperventilation and seizures, its use in the clinical practice, and possible mechanisms involved.
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Affiliation(s)
- Mandeep Rana
- Department of Pediatrics, Section of Pediatric Neurology, Carilion Clinic, Virginia Tech Carilion School of Medicine Roanoke, Virginia, United States
| | - Maija Steenari
- Department of Pediatrics, University of California, Irvine Division of Neurology, CHOC, 1201 W La Veta Avenue, Orange, California, United States
| | - Daniel Shrey
- Department of Pediatrics, University of California, Irvine Division of Neurology, CHOC, 1201 W La Veta Avenue, Orange, California, United States
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Cousyn L, Dono F, Navarro V, Chavez M. Can heart rate variability identify a high-risk state of upcoming seizure? Epilepsy Res 2023; 197:107232. [PMID: 37783038 DOI: 10.1016/j.eplepsyres.2023.107232] [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: 05/23/2023] [Revised: 08/10/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
Heart rate variability (HRV) is an accessible and convenient means to assess the sympathetic/parasympathetic balance. Autonomic dysfunctions may reflect a pro-ictal state and occur before the seizure onset. Previous studies have reported HRV-based models to identify preictal states in continuous electrocardiogram (EKG) monitoring. Here, we evaluated the ability of HRV metrics extracted from daily single resting-state periods to estimate the risk of upcoming seizure(s) using probabilistic forecasts. Daily standardized 10-min vigilance-controlled EKG periods were recorded in 15 patients with drug-resistant focal epilepsy who underwent intracerebral electroencephalography (EEG). Analyses of a total of 156 periods, based on machine learning approaches, suggested that HRV features can identify preictal states with a median AUC of 0.75 [0.68;0.99]. Pseudoprospective daily forecasts yielded a median Brier score of 0.3 [0.18;0.48]. About 60% of preictal days were correctly forecasted, while false positive predictions were noticed in 24% of interictal days. Daily resting HRV seems to capture information on autonomic variations that may reflect a pro-ictal state. The method could be embedded in an ambulatory clinical seizure prediction device, but additional modalities (prodromes, EEG-based features, etc.) should be associated to improve its performance.
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Affiliation(s)
- Louis Cousyn
- Paris Brain Institute (Inserm, CNRS, Sorbonne Université), Paris, France; AP-HP, Department of Neurology, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France.
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti -Pescara, Chieti, Italy
| | - Vincent Navarro
- Paris Brain Institute (Inserm, CNRS, Sorbonne Université), Paris, France; AP-HP, Department of Neurology, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Mario Chavez
- CNRS UMR-7225, Pitié-Salpêtrière Hospital, Paris, France
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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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Kim W, Lee H, Lee KW, Yang E, Kim S. The Association of Nocturnal Seizures and Interictal Cardiac/Central Autonomic Function in Frontal Lobe Epilepsy: Heart Rate Variability and Central Autonomic Network Analysis. Neuropsychiatr Dis Treat 2023; 19:2081-2091. [PMID: 37810949 PMCID: PMC10559795 DOI: 10.2147/ndt.s426263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose Patients with epilepsy frequently experience autonomic dysfunction, closely related to sudden unexplained death in epilepsy (SUDEP). SUDEP occurs most often at night or during sleep, and frequent nocturnal seizures are an established risk factor. This study investigated the influence of nocturnal seizures on autonomic dysfunction in epilepsy. Patients and Methods This retrospective study enrolled frontal lobe epilepsy (FLE) patients who performed 24-hour EEG monitoring. All participants were divided into nocturnal FLE (NFLE, > 90% of seizures occurring during sleep) or diurnal FLE (DFLE) groups. EEG and ECG signals were simultaneously obtained during waking and sleep stages. EEG current density source and connectivity analysis of the autonomic network were performed. ECG was analyzed across time and frequency domains heart rate variability (HRV) analysis method was used. The obtained parameters were compared between the NFLE and DFLE groups. Results Fifteen NFLE and 16 DFLE patients were enrolled with no significant difference in age, sex, disease duration, seizure frequency, or the number of anti-seizure medications between the two groups. During sleep, a decrease in HRV parameters and an increase of the beta-1 (13-22 Hz) current source density power in the bilateral paracentral lobule (BA4,5,6), precuneus (BA7), and cingulate (BA31) were observed in the NFLE group compared to DFLE group. The NFLE group also showed hyperconnectivity in the central autonomic (12 edges distributed over 10 nodes), sympathetic (2 edges distributed over 3 nodes), and parasympathetic (4 edges distributed over 6 nodes) beta-1 frequency band networks during sleep. During wakefulness, central and cardiac autonomic variables were not significantly different between the NFLE and DFLE groups. Conclusion Interictal cardiac and central autonomic dysfunction occurred simultaneously and can be attributed to the brain-heart autonomic axis. Our findings suggest that nocturnal seizures may contribute to interictal autonomic dysfunction during sleep in people with epilepsy.
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Affiliation(s)
- Woojun Kim
- Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunjo Lee
- Department of Neurology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Kyung Won Lee
- Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunjin Yang
- Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seonghoon Kim
- Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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16
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Ryan JM, Wagner KT, Yerram S, Concannon C, Lin JX, Rooney P, Hanrahan B, Titoff V, Connolly NL, Cranmer R, DeMaria N, Xia X, Mykins B, Erickson S, Couderc JP, Schifitto G, Hughes I, Wang D, Erba G, Auerbach DS. Heart rate and autonomic biomarkers distinguish convulsive epileptic vs. functional or dissociative seizures. Seizure 2023; 111:178-186. [PMID: 37660533 DOI: 10.1016/j.seizure.2023.08.015] [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: 06/09/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE 20-40% of individuals whose seizures are not controlled by anti-seizure medications exhibit manifestations comparable to epileptic seizures (ES), but there are no EEG correlates. These events are called functional or dissociative seizures (FDS). Due to limited access to EEG-monitoring and inconclusive results, we aimed to develop an alternative diagnostic tool that distinguishes ES vs. FDS. We evaluated the temporal evolution of ECG-based measures of autonomic function (heart rate variability, HRV) to determine whether they distinguish ES vs. FDS. METHODS The prospective study includes patients admitted to the University of Rochester Epilepsy Monitoring Unit. Participants are 18-65 years old, without therapies or co-morbidities associated with altered autonomics. A habitual ES or FDS is recorded during admission. HRV analysis is performed to evaluate the temporal changes in autonomic function during the peri‑ictal period (150-minutes each pre-/post-ictal). We determined if autonomic measures distinguish ES vs. FDS. RESULTS The study includes 53 ES and 46 FDS. Temporal evolution of HR and autonomics significantly differ surrounding ES vs. FDS. The pre-to-post-ictal change (delta) in HR differs surrounding ES vs. FDS, stratified for convulsive and non-convulsive events. Post-ictal HR, total autonomic (SDNN & Total Power), vagal (RMSSD & HF), and baroreflex (LF) function differ for convulsive ES vs. convulsive FDS. HR distinguishes non-convulsive ES vs. non-convulsive FDS with ROC>0.7, sensitivity>70%, but specificity<50%. HR-delta and post-ictal HR, SDNN, RMSSD, LF, HF, and Total Power each distinguish convulsive ES vs. convulsive FDS (ROC, 0.83-0.98). Models with HR-delta and post-ictal HR provide the highest diagnostic accuracy for convulsive ES vs. convulsive FDS: 92% sensitivity, 94% specificity, ROC 0.99). SIGNIFICANCE HR and HRV measures accurately distinguish convulsive, but not non-convulsive, events (ES vs. FDS). Results establish the framework for future studies to apply this diagnostic tool to more heterogeneous populations, and on out-of-hospital recordings, particularly for populations without access to epilepsy monitoring units.
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Affiliation(s)
- Justin M Ryan
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Kyle T Wagner
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Sushma Yerram
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Cathleen Concannon
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Jennifer X Lin
- School of Medicine, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Patrick Rooney
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Brian Hanrahan
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Victoria Titoff
- Department of Neurology-Epilepsy, SUNY Upstate Medical University, Syracuse, NY 13210, United States; Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Noreen L Connolly
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Ramona Cranmer
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Natalia DeMaria
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Xiaojuan Xia
- Clinical Cardiology Research Center Medicine-Cardiology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Betty Mykins
- Clinical Cardiology Research Center Medicine-Cardiology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Steven Erickson
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Jean-Philippe Couderc
- Clinical Cardiology Research Center Medicine-Cardiology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Inna Hughes
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Dongliang Wang
- Department of Public Health, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Giuseppe Erba
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - David S Auerbach
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States.
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Nakamura H, Sugihara G, Hara K, Inaji M, Noha M, Takumi I, Watanabe M, Takahashi H, Maehara T, Yamamoto H, Takagi S. Seizure-related stress and arousal responses mediate a relationship between anxiety trait and state in epilepsy. Epilepsy Behav 2023; 147:109442. [PMID: 37716325 DOI: 10.1016/j.yebeh.2023.109442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Epilepsy causes substantial psychological distress and anxiety, primarily due to seizures. However, the impact of stress responses and changes in arousal and their association with anxiety patterns in patients with epilepsy (PWE) remains unclear. This study aimed to investigate the relationships among seizures, stress and arousal characteristics, and trait and state anxiety characteristics in PWE. METHODS Our sample consisted of 159 outpatients with epilepsy recruited from five institutions in Japan in 2020. Participants completed the State-Trait Anxiety Inventory-Form JYZ (STAI) and the Japanese-Stress Arousal Check List (J-SACL). We analyzed the correlations between inventory scores and clinical information. Using principal component analysis (PCA), we derived epilepsy-specific stress/arousal characteristics, which accounted for high arousal and low-stress levels, termed epilepsy-specific stress or arousal response (ESAR), from the J-SACL scores. We conducted a mediation analysis to assess the mediating role of ESAR in the relationship between traits and state anxiety. RESULTS We found significant correlations between J-SACL stress and arousal factors (r = -0.845, p < 0.001), ESAR and seizure frequency (r = -0.29, p < 0.001), ESAR and trait anxiety scores on the STAI (r = -0.77, p < 0.0001), and ESAR and state anxiety scores on the STAI (r = -0.60, p < 0.0001). Mediation analysis supported by the Monte Carlo method revealed that ESAR significantly mediated the association between trait and state anxiety. CONCLUSIONS These findings elucidate the epilepsy-specific stress and arousal characteristics and their roles in mediating traits and state anxiety. These results may reflect the long-term clinical course and unique emotion recognition tendencies in epilepsy.
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Affiliation(s)
- Hironobu Nakamura
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Hara Clinic, Kanagawa, Japan
| | - Genichi Sugihara
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Keiko Hara
- Hara Clinic, Kanagawa, Japan; Department of Respiratory and Nervous System Science, Biomedical Laboratory Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Noha
- Department of Neurosurgery, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Ichiro Takumi
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitoshi Yamamoto
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shunsuke Takagi
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Sleep Research Institute, Waseda University, 513 Waseda-Tsurumakicho, Shinjuku, Tokyo 162-0041 Japan.
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18
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Leosuthamas D, Limotai C, Unwanatham N, Rattanasiri S. Is anti-seizure medication the culprit of SUDEP? Neurol Sci 2023; 44:3659-3668. [PMID: 37248425 DOI: 10.1007/s10072-023-06871-0] [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: 02/02/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Heart rate variability (HRV) reduction is a potential biomarker for sudden cardiac death. This study aimed to study the effects of anti-seizure medications (ASMs), adjusted with reported factors associated with sudden unexpected death in epilepsy (SUDEP) on HRV parameters. METHODS We recruited patients who were admitted in our epilepsy monitoring unit between January 2013 and December 2021. Two 5-min electrocardiogram epochs during wakefulness and sleep were selected in each patient. HRV analysis with Python® software was performed. The imputed datasets were used for linear regression analysis to assess association between each ASM item and all HRV parameters. The effects of ASM on HRV parameters were subsequently adjusted with the significant clinical characteristics and the concomitant use of other ASMs, respectively. RESULTS Carbamazepine (CBZ), levetiracetam (LEV), lamotrigine (LTG), and clonazepam (CZP) were statistically significantly associated with changes of sleep HRV parameters. Only CBZ showed negative effects with reduction in HRV, evidenced as lower standard deviation of RR interval (SDNN), even when adjusted with concomitant use of other ASMs (p = 0.045) and had a trend of significance when adjusted with significant clinical characteristics of concurrent taking of beta-blocker drug (p = 0.052). LEV and CZP showed opposite effects with increased HRV even when adjusted with significant clinical characteristics and the concomitant use of other ASMs. CONCLUSIONS CBZ showed negative effects on HRV. We proposed that CBZ should be cautiously used in patients with known risks for SUDEP. In addition, HRV assessment should be performed prior to commencing CBZ and re-performed in follow-up in cases of prolonged use.
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Affiliation(s)
- Danist Leosuthamas
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chusak Limotai
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC), King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
- Division of Neurology, King Chulalongkorn Memorial Hospital, 1873 Seventh Floor Bhumisiri Building, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Nattawut Unwanatham
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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19
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Nguyen VD, Pham DT, Le MAT, Shen GM. Effect on Satisfactory Seizure Control and Heart Rate Variability of Thread-Embedding Acupuncture for Drug-Resistant Epilepsy: A Patient-Assessor Blinded, Randomized Controlled Trial. Behav Neurol 2023; 2023:5871991. [PMID: 37767181 PMCID: PMC10522444 DOI: 10.1155/2023/5871991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
This randomized controlled trial investigates the efficacy of thread-embedding acupuncture (TEA) compared to sham TEA in treating drug-resistant epilepsy (DRE). Fifty-four DRE outpatients were randomly divided into two groups: TEA (27 patients) and sham TEA (27 patients). Both groups received four sessions of TEA or sham TEA, spaced four weeks apart, targeting GV20, GV14, BL15, BL18, ST40, and GB34 acupoints. Antiseizure medications were maintained at consistent doses throughout the study. Outcome measures included satisfactory seizure control, seizure freedom, and heart rate (HR) and heart rate variability (HRV) measurements. TEA demonstrated a significantly higher rate of satisfactory seizure control at follow-up compared to the sham TEA group (37% vs. 3.7%, p = 0.003). While no significant intergroup differences were observed in HR, HRV, and HRV components at each stage, the TEA group experienced a significant decrease in HR and a significant increase in HRV posttreatment. This study demonstrates TEA's effectiveness in managing DRE and suggests its impact may relate to heightened parasympathetic nerve activity. Further research with extended follow-up periods is necessary to validate these findings.
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Affiliation(s)
- Van-Dan Nguyen
- School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, 230012 Anhui Province, China
- Faculty of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 100000, Vietnam
| | - Duc-Thang Pham
- Faculty of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 100000, Vietnam
| | - Minh-An Thuy Le
- Department of Neurology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 100000, Vietnam
| | - Guo-Ming Shen
- School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, 230012 Anhui Province, China
- Institute of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, 230012 Anhui Province, China
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20
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Fialho GL, Pang TD, Kong WY, Tran AP, Yu CG, Rodriguez ID, Nearing BD, Waks JW, Maher TR, Clarke JR, Shepherd A, D'Avila A, Schachter SC, Verrier RL. Individuals with chronic epilepsy have elevated P-wave heterogeneity comparable to patients with atrial fibrillation. Epilepsia 2023; 64:2361-2372. [PMID: 37329175 DOI: 10.1111/epi.17686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Identification of epilepsy patients with elevated risk for atrial fibrillation (AF) is critical given the heightened morbidity and premature mortality associated with this arrhythmia. Epilepsy is a worldwide health problem affecting nearly 3.4 million people in the United States alone. The potential for increased risk for AF in patients with epilepsy is not well appreciated, despite recent evidence from a national survey of 1.4 million hospitalizations indicating that AF is the most common arrhythmia in people with epilepsy. METHODS We analyzed inter-lead heterogeneity of P-wave morphology, a marker reflecting arrhythmogenic nonuniformities of activation/conduction in atrial tissue. The study groups consisted of 96 patients with epilepsy and 44 consecutive patients with AF in sinus rhythm before clinically indicated ablation. Individuals without cardiovascular or neurological conditions (n = 77) were also assessed. We calculated P-wave heterogeneity (PWH) by second central moment analysis of simultaneous beats from leads II, III, and aVR ("atrial dedicated leads") from standard 12-lead electrocardiography (ECG) recordings from admission day to the epilepsy monitoring unit (EMU). RESULTS Female patients composed 62.5%, 59.6%, and 57.1% of the epilepsy, AF, and control subjects, respectively. The AF cohort was older (66 ± 1.1 years) than the epilepsy group (44 ± 1.8 years, p < .001). The level of PWH was greater in the epilepsy group than in the control group (67 ± 2.6 vs. 57 ± 2.5 μV, p = .046) and reached levels observed in AF patients (67 ± 2.6 vs. 68 ± 4.9 μV, p = .99). In multiple linear regression analysis, PWH levels in individuals with epilepsy were mainly correlated with the PR interval and could be related to sympathetic tone. Epilepsy remained associated with PWH after adjustments for cardiac risk factors, age, and sex. SIGNIFICANCE Patients with chronic epilepsy have increased PWH comparable to levels observed in patients with AF, while being ~20 years younger, suggesting an acceleration in structural change and/or cardiac electrical instability. These observations are consistent with emerging evidence of an "epileptic heart" condition.
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Affiliation(s)
- Guilherme L Fialho
- Federal University of Santa Catarina, Florianopolis, Brazil
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Trudy D Pang
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Wan Yee Kong
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Anthony P Tran
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Calvin G Yu
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Ivo D Rodriguez
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Bruce D Nearing
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Jonathan W Waks
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Timothy R Maher
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - John-Ross Clarke
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Alyssa Shepherd
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Andre D'Avila
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Steven C Schachter
- Departments of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Richard L Verrier
- Departments of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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21
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Perulli M, Scala I, Venditti R, Amadio A, Luigia Gambardella M, Quintiliani M, Contaldo I, Veredice C, Della Marca G, Brunetti V, Battaglia DI. Short- vs long-term assessment of heart rate variability: Clinical significance in Dravet Syndrome. Epilepsy Behav 2023; 146:109357. [PMID: 37499580 DOI: 10.1016/j.yebeh.2023.109357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Heart rate variability (HRV) is a promising prognostic biomarker in Dravet Syndrome (DS), but different studies are not always comparable, limiting its clinical application. In fact, multiple HRV parameters, analyzed over different timescales and in different states are reported. The aim of this study was to assess which HRV parameter is more reproducible and clinically significant, analyzing differences between wake and sleep. METHOD Patients with DS, with available 24 h-ECG Holter-derived HRV, were screened to evaluate if they had EEG-derived ECG traces available within one month before/after the Holter. A 5-minute period in the awake and sleep state were analyzed and correlated with the 24 h-HRV. Several relevant clinical features such as age, a recent history of status epilepticus (SE), and frequent generalized tonic-clonic seizures (GTCS) were correlated to HRV parameters with multiple linear regression models. RESULTS Thirty-oneawake recordings and 22 sleep recordings were included. HF was the parameter with the highest correlation in awake (Rho 0.745, p < 0.001) and in sleep (Rho 0.727, p < 0.001). Age was a significant factor in simple models for most of the parameters except RMSSD. A recent history of SE was associated with a significant reduction of HRV, both in simple and multiple regressions for all parameters except for awake LF and for sleep RMSSD and PNN50. Frequent GTCS were associated with a significant decrease in sleep RMSSD, HF, and LF, also when correcting for the effect of age and history of SE. When compared pairwise, a significant increase in sleep was seen for HF (median + 24.45 ms2, IQR -7.51/+172.18 ms2, p = 0.036; increase in 15/22 patients). CONCLUSION A moderate degree of correlation between long- and short-term HRV was seen both in sleep and in awake, and a strong correlation for awake HF. HF, both in awake and sleep, was significantly associated with high seizure burden, including SE and frequent GTCS.
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Affiliation(s)
- Marco Perulli
- Neuropsichiatria Infantile, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Irene Scala
- Università Cattolica del Sacro Cuore, Rome, Italy; Neurologia, Dipartimento di Scienze Dell'invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Romina Venditti
- Neuropsichiatria Infantile, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Amadio
- Università Cattolica del Sacro Cuore, Rome, Italy; Neurologia, Dipartimento di Scienze Dell'invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Luigia Gambardella
- Neuropsichiatria Infantile, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michela Quintiliani
- Neuropsichiatria Infantile, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Contaldo
- Neuropsichiatria Infantile, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Veredice
- Neuropsichiatria Infantile, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giacomo Della Marca
- Università Cattolica del Sacro Cuore, Rome, Italy; Neurologia, Dipartimento di Scienze Dell'invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valerio Brunetti
- Università Cattolica del Sacro Cuore, Rome, Italy; Neurologia, Dipartimento di Scienze Dell'invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenica Immacolata Battaglia
- Neuropsichiatria Infantile, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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22
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van den Broek N, van Meulen F, Ross M, Cerny A, Anderer P, van Gilst M, Pillen S, Overeem S, Fonseca P. Automated sleep staging in people with intellectual disabilities using heart rate and respiration variability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023. [PMID: 37291951 DOI: 10.1111/jir.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) have a higher risk of sleep disorders. Polysomnography (PSG) remains the diagnostic gold standard in sleep medicine. However, PSG in people with ID can be challenging, as sensors can be burdensome and have a negative influence on sleep. Alternative methods of assessing sleep have been proposed that could potentially transfer to less obtrusive monitoring devices. The goal of this study was to investigate whether analysis of heart rate variability and respiration variability is suitable for the automatic scoring of sleep stages in sleep-disordered people with ID. METHODS Manually scored sleep stages in PSGs of 73 people with ID (borderline to profound) were compared with the scoring of sleep stages by the CardioRespiratory Sleep Staging (CReSS) algorithm. CReSS uses cardiac and/or respiratory input to score the different sleep stages. Performance of the algorithm was analysed using input from electrocardiogram (ECG), respiratory effort and a combination of both. Agreement was determined by means of epoch-per-epoch Cohen's kappa coefficient. The influence of demographics, comorbidities and potential manual scoring difficulties (based on comments in the PSG report) was explored. RESULTS The use of CReSS with combination of both ECG and respiratory effort provided the best agreement in scoring sleep and wake when compared with manually scored PSG (PSG versus ECG = kappa 0.56, PSG versus respiratory effort = kappa 0.53 and PSG versus both = kappa 0.62). Presence of epilepsy or difficulties in manually scoring sleep stages negatively influenced agreement significantly, but nevertheless, performance remained acceptable. In people with ID without epilepsy, the average kappa approximated that of the general population with sleep disorders. CONCLUSIONS Using analysis of heart rate and respiration variability, sleep stages can be estimated in people with ID. This could in the future lead to less obtrusive measurements of sleep using, for example, wearables, more suitable to this population.
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Affiliation(s)
- N van den Broek
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
| | - F van Meulen
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M Ross
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Vienna, Austria
| | - A Cerny
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Vienna, Austria
| | - P Anderer
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Vienna, Austria
| | - M van Gilst
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S Pillen
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
| | - S Overeem
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - P Fonseca
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
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23
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Neri L, Oberdier MT, van Abeelen KCJ, Menghini L, Tumarkin E, Tripathi H, Jaipalli S, Orro A, Paolocci N, Gallelli I, Dall’Olio M, Beker A, Carrick RT, Borghi C, Halperin HR. Electrocardiogram Monitoring Wearable Devices and Artificial-Intelligence-Enabled Diagnostic Capabilities: A Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:4805. [PMID: 37430719 PMCID: PMC10223364 DOI: 10.3390/s23104805] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 07/12/2023]
Abstract
Worldwide, population aging and unhealthy lifestyles have increased the incidence of high-risk health conditions such as cardiovascular diseases, sleep apnea, and other conditions. Recently, to facilitate early identification and diagnosis, efforts have been made in the research and development of new wearable devices to make them smaller, more comfortable, more accurate, and increasingly compatible with artificial intelligence technologies. These efforts can pave the way to the longer and continuous health monitoring of different biosignals, including the real-time detection of diseases, thus providing more timely and accurate predictions of health events that can drastically improve the healthcare management of patients. Most recent reviews focus on a specific category of disease, the use of artificial intelligence in 12-lead electrocardiograms, or on wearable technology. However, we present recent advances in the use of electrocardiogram signals acquired with wearable devices or from publicly available databases and the analysis of such signals with artificial intelligence methods to detect and predict diseases. As expected, most of the available research focuses on heart diseases, sleep apnea, and other emerging areas, such as mental stress. From a methodological point of view, although traditional statistical methods and machine learning are still widely used, we observe an increasing use of more advanced deep learning methods, specifically architectures that can handle the complexity of biosignal data. These deep learning methods typically include convolutional and recurrent neural networks. Moreover, when proposing new artificial intelligence methods, we observe that the prevalent choice is to use publicly available databases rather than collecting new data.
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Affiliation(s)
- Luca Neri
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Matt T. Oberdier
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Kirsten C. J. van Abeelen
- Department of Informatics, Systems, and Communication, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Internal Medicine, Radboud University Medical Center, 6525 AJ Nijmegen, The Netherlands
| | - Luca Menghini
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Ethan Tumarkin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Hemantkumar Tripathi
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Sujai Jaipalli
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Alessandro Orro
- Institute of Biomedical Technologies, National Research Council, 20054 Segrate, Italy
| | - Nazareno Paolocci
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Ilaria Gallelli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Massimo Dall’Olio
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Amir Beker
- AccYouRate Group S.p.A., 67100 L’Aquila, Italy
| | - Richard T. Carrick
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Henry R. Halperin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Radiology, Johns Hopkins University, Baltimore, MD 21205, USA
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24
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Lőrincz K, Bóné B, Karádi K, Kis-Jakab G, Tóth N, Halász L, Erőss L, Balás I, Faludi B, Jordán Z, Chadaide Z, Gyimesi C, Fabó D, Janszky J. Effects of anterior thalamic nucleus DBS on interictal heart rate variability in patients with refractory epilepsy. Clin Neurophysiol 2023; 147:17-30. [PMID: 36630886 DOI: 10.1016/j.clinph.2022.11.020] [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: 08/14/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Heart rate variability (HRV) changes were investigated by several studies after resective epilepsy surgery/vagus nerve stimulation. We examined anterior thalamic nucleus (ANT)-deep brain stimulation (DBS) effects on HRV parameters. METHODS We retrospectively analyzed 30 drug-resistant epilepsy patients' medical record data and collected electrocardiographic epochs recorded during video- electroencephalography monitoring sessions while awake and during N1- or N2-stage sleep pre-DBS implantation surgery, post-surgery but pre-stimulation, and after stimulation began. RESULTS The mean square root of the mean squared differences between successive RR intervals and RR interval standard deviation values differed significantly (p < 0.05) among time-points, showing increased HRV post-surgery. High (0.15-0.4 Hz) and very low frequency (<0.04 Hz) increased, while low frequency (0.04-0.15 Hz) and the LF/HF ratio while awake decreased, suggesting improved autonomic regulation post-surgery. Change of effect size was larger in patients where both activated contacts were located in the ANT than in those where only one or none of the contacts hit the ANT. CONCLUSIONS In patients with drug-resistant epilepsy, ANT-DBS might positively influence autonomic regulation, as reflected by increased HRV. SIGNIFICANCE To gain a more comprehensive outcome estimation after DBS implantation, we suggest including HRV measures with seizure count in the post-surgery follow-up protocol.
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Affiliation(s)
- Katalin Lőrincz
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler str. 3, 72076 Tübingen, Germany.
| | - Beáta Bóné
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Kázmér Karádi
- Department of Behavioral Sciences, Medical School, University of Pecs, Szigeti u.12, H-7624 Pecs, Hungary
| | - Greta Kis-Jakab
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Ret u. 2., H-7623 Pecs, Hungary
| | - Natália Tóth
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - László Halász
- Department of Functional Neurosurgery, National Institute of Neurosciences, Amerikai ut 57, H-1345 Budapest, Hungary
| | - Loránd Erőss
- Department of Functional Neurosurgery, National Institute of Neurosciences, Amerikai ut 57, H-1345 Budapest, Hungary
| | - István Balás
- Department of Neurosurgery, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Béla Faludi
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Zsófia Jordán
- Department of Neurology, National Institute of Neurosciences, Amerikai ut 57., H-1345 Budapest, Hungary
| | - Zoltan Chadaide
- University of Szeged Albert Szentgyörgyi Medical School, Tisza Lajos krt.109, 6725 Szeged, Hungary
| | - Csilla Gyimesi
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Dániel Fabó
- Department of Neurology, National Institute of Neurosciences, Amerikai ut 57., H-1345 Budapest, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Ret u. 2., H-7623 Pecs, Hungary
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25
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Frequency, risk factors, and impacts on quality of life of the restless legs syndrome and side effects among antidepressant users in a tertiary hospital: an observational cross-sectional study. Int Clin Psychopharmacol 2023:00004850-990000000-00052. [PMID: 36853797 DOI: 10.1097/yic.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Restless leg syndrome (RLS) is a common but underestimated sensorimotor disorder that significantly affects the quality of life (QoL) which can be induced by antidepressants. This study aims to investigate the frequency and potential risk factors of RLS and side effects in selective serotonin reuptake inhibitors/serotonin and noradrenaline reuptake inhibitors (SSRI/SNRI) users. This cross-sectional study included 198 outpatients who received SSRI/SNRI for 4-8 weeks. Clinical evaluation was performed using the International Restless Leg Syndrome Study Group rating scale for RLS, Udvalg for Kliniske Undersøgelser side effects rating scale, and a short form 36 (SF-36) questionnaire for QoL. The frequency of RLS was 25%. RLS significantly increased with smoking and habituality. Also, habituality increased neurologic side effects reporting. The use of antipsychotics and calcium channel blockers decreased reporting of autonomic side effects. QoL decreased with RLS, psychiatric, neurologic, autonomic, and other side effects in different domains of SF-36. These findings suggested that SSRI/SNRI use could be associated with a higher risk of RLS, especially in smokers. QoL could be influenced negatively by RLS and all side effects. However, further prospective studies are needed to confirm these associations in large samples.
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26
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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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27
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Rodriguez-Quintana J, Bueno-Florez S, Mora-Muñoz L, Orrego-González E, Barragan AM, Suárez-Burgos F, Velez-Van-Meerbeke A, Cendes F. Dysautonomia in people with epilepsy: A scoping review. Seizure 2023; 105:43-51. [PMID: 36702019 DOI: 10.1016/j.seizure.2022.12.003] [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: 03/30/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Epilepsy is one of the most common neurological diseases and has high morbidity and mortality. Multiple methods for assessing dysautonomia have been reported; however, the patient characteristics and epilepsy features that drive any method selection are unclear. People with epilepsy (PWE) can experience sudden unexpected death in epilepsy (SUDEP) and one reason can be dysautonomia. If dysautonomia can be detected in PWE before a severe event, then it could complement and redirect patient treatment and monitoring. OBJECTIVE To map the available literature on dysautonomia in PWE and describe patients' characteristics and methods used to evaluate dysautonomia. METHODS We performed a scoping literature review. We searched PubMed, Scopus, Embase, and hand searched starting from the first registry in the literature until August 2019. Studies were independently assessed by three authors and two epileptologists. We present data in tables and summarize information according to the following structure: population, concepts, and context. RESULTS Thirty-five studies were included in the analysis with epidemiological designs including case reports (23), cross-sectional studies (4), case‒controls (7), and cohort studies (1). A total of 618 patients were enrolled. Heart rate variability, arrhythmia, blood pressure, the tilt-table test, polysomnography, respiratory function, and magnetic resonance imaging were the methods most commonly used to assess dysautonomia in PWE. A detailed description of the heart rate variability assessment is presented. CONCLUSIONS This review provides a broad description of the available literature identifying clinical findings, the most frequently reported assessment measurements of dysautonomia, in temporal lobe epilepsy and extratemporal epilepsies.
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Affiliation(s)
- Jesús Rodriguez-Quintana
- Neuroscience Research Group NEUROS, School of Medicine and Health Sciences, Universidad del Rosario, Adress: Carrera 24 N° 63C-69, Bogota. Colombia; Fundación Cardioinfantil, Adress: Calle 163A # 13B - 60, Bogota. Colombia; Colombia Hospital Universitario Mayor (MEDERI), Adress: Cl 24 # 29 45, Bogota. Colombia
| | | | - Laura Mora-Muñoz
- Neuroscience Research Group NEUROS, School of Medicine and Health Sciences, Universidad del Rosario, Adress: Carrera 24 N° 63C-69, Bogota. Colombia
| | - Eduardo Orrego-González
- Neuroscience Research Group NEUROS, School of Medicine and Health Sciences, Universidad del Rosario, Adress: Carrera 24 N° 63C-69, Bogota. Colombia
| | - Ana M Barragan
- School of Medicine and Health Sciences, Public Health Research Group, Universidad del Rosario, Bogotá, Adress: Carrera 24 N° 63C-69, Bogotá, Colombia
| | | | - Alberto Velez-Van-Meerbeke
- Neuroscience Research Group NEUROS, School of Medicine and Health Sciences, Universidad del Rosario, Adress: Carrera 24 N° 63C-69, Bogota. Colombia
| | - Fernando Cendes
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Cidade Universitária Zeferino Vaz, Rua Tessália Vieira de Camargo, 126, 13083-888, Campinas, SP, Brazil
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28
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The Endocannabinoid System and Physical Exercise. Int J Mol Sci 2023; 24:ijms24031989. [PMID: 36768332 PMCID: PMC9916354 DOI: 10.3390/ijms24031989] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
The endocannabinoid system (ECS) is involved in various processes, including brain plasticity, learning and memory, neuronal development, nociception, inflammation, appetite regulation, digestion, metabolism, energy balance, motility, and regulation of stress and emotions. Physical exercise (PE) is considered a valuable non-pharmacological therapy that is an immediately available and cost-effective method with a lot of health benefits, one of them being the activation of the endogenous cannabinoids. Endocannabinoids (eCBs) are generated as a response to high-intensity activities and can act as short-term circuit breakers, generating antinociceptive responses for a short and variable period of time. A runner's high is an ephemeral feeling some sport practitioners experience during endurance activities, such as running. The release of eCBs during sustained physical exercise appears to be involved in triggering this phenomenon. The last decades have been characterized by an increased interest in this emotional state induced by exercise, as it is believed to alleviate pain, induce mild sedation, increase euphoric levels, and have anxiolytic effects. This review provides information about the current state of knowledge about endocannabinoids and physical effort and also an overview of the studies published in the specialized literature about this subject.
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29
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Direk MÇ, Epcacan S, Özdemir AA, Uysal F, Okuyaz Ç. Effects of levetiracetam treatment on autonomic nervous system functions in pediatric epilepsy patients. Pediatr Int 2023; 65:e15636. [PMID: 37795856 DOI: 10.1111/ped.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND This study investigated the effects of levetiracetam (LEV) treatment on cardiac rhythm and heart rate variability. METHODS The study included two groups of patients diagnosed with non-lesional epilepsy who had not yet been treated and who presented to the outpatient pediatric neurology clinic at Van Training and Research Hospital, Van, Turkey, between 2019 and 2020. The heart rate variability (HRV) of 47 patients in the first group, before and at the 3rd month of treatment, and intravenous (IV) LEV loading in 13 patients in the second group was evaluated by Holter electrocardiography (ECG). RESULTS It was determined that the values of triangular index, standard deviation of the RR intervals over a 24-hour period (SDNN), standard deviation of all 5-minute mean RR intervals (SDANN), mean of standard deviations of all normal RR intervals (SDNNI), the percentage of RR intervals with >50-millisecond variation (PNN50), and the square root of mean squared differences of successive RR intervals (RMSSD). HRV of 47 patients under LEV treatment significantly increased in the 3rd month of treatment compared to baseline (p < 0.05). No difference was found in HRV between the intravenous loading and the control group (p > 0.05). CONCLUSIONS Our study suggests that the sympathovagal balance before treatment in the patient group is in favor of the sympathetic nervous system and that the sympathovagal imbalance improves after treatment. Our results show that LEV monotherapy and loading have no negative effect on HRV and potential cardiac arrhythmia risk in children with epilepsy.
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Affiliation(s)
| | - Serdar Epcacan
- Department of Pediatric Cardiology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Asena Ayca Özdemir
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Fahrettin Uysal
- Department of Turkey Pediatric Cardiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Çetin Okuyaz
- Department of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
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van den Bongard F, Coenen J, Reinsberger C. Fitness, performance, and cardiac autonomic responses to exercise in people with epilepsy. Epilepsy Behav 2022; 135:108869. [PMID: 36037579 DOI: 10.1016/j.yebeh.2022.108869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/28/2022] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
Abstract
People with epilepsy (PWE) are less fit and have an increased risk of sudden cardiac death. Imbalances within the autonomic nervous system (ANS) are believed to mediate some of those effects. However, results are mostly derived from patients whose seizures are refractory to medical therapy. In this study, an exhaustive bicycle ergometer test was delivered to 25 PWE (19 seizure free in the last 6 months) recruited in a community-based setting and 25 age-, sex-, and BMI-matched healthy controls. During the exercise test a 12-channel ECG was recorded and spirometry was carried out to determine the maximal oxygen uptake (VO2peak) as the gold standard to assess fitness. Before and after exercise, heart rate variability (HRV) and electrodermal activity (EDA) were measured along with an electroencephalogram (EEG). Blood samples were collected to determine anti-seizure drug (ASD) serum levels and physical activity of daily living was evaluated via the International Physical Activity Questionnaire (IPAQ). People with epilepsy and healthy controls were similarly fit and physically active. However, PWE had a lower maximum heart rate, a lower heart rate reserve, and a lower chronotropic index. The ratio between low- to high-frequency HRV changes (LF/HF ratio) was lower in PWE. Two patients with idiopathic genetic epilepsies revealed generalized interictal epileptiform discharges only after, but not before exercise. However, post-exercise EEG measurement was three times longer than pre-exercise and those patients did not report exercise induced seizures in the history. Besides epileptogenesis, anti-seizure medications may also contribute to those autonomic differences.
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Affiliation(s)
| | - Jessica Coenen
- Institute of Sports Medicine, Paderborn University, Germany
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Wired for sound: The effect of sound on the epileptic brain. Seizure 2022; 102:22-31. [PMID: 36179456 DOI: 10.1016/j.seizure.2022.09.016] [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: 06/08/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Sound waves are all around us resonating at audible and inaudible frequencies. Our ability to hear is crucial in providing information and enabling interaction with our environment. The human brain generates neural oscillations or brainwaves through synchronised electrical impulses. In epilepsy these brainwaves can change and form rhythmic bursts of abnormal activity outwardly appearing as seizures. When two waveforms meet, they can superimpose onto one another forming constructive, destructive or mixed interference. The effects of audible soundwaves on epileptic brainwaves has been largely explored with music. The Mozart Sonata for Two Pianos in D major, K. 448 has been examined in a number of studies where significant clinical and methodological heterogeneity exists. These studies report variable reductions in seizures and interictal epileptiform discharges. Treatment effects of Mozart Piano Sonata in C Major, K.545 and other composer interventions have been examined with some musical exposures, for example Hayden's Symphony No. 94 appearing pro-epileptic. The underlying anti-epileptic mechanism of Mozart music is currently unknown, but interesting research is moving away from dopamine reward system theories to computational analysis of specific auditory parameters. In the last decade several studies have examined inaudible low intensity focused ultrasound as a neuro-modulatory intervention in focal epilepsy. Whilst acute and chronic epilepsy rodent model studies have consistently demonstrated an anti-epileptic treatment effect this is yet to be reported within large scale human trials. Inaudible infrasound is of concern since at present there are no reported studies on the effects of exposure to infrasound on epilepsy. Understanding the impact of infrasound on epilepsy is critical in an era where sustainable energies are likely to increase exposure.
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Tripska K, Draessler J, Pokladnikova J. Heart rate variability, perceived stress and willingness to seek counselling in undergraduate students. J Psychosom Res 2022; 160:110972. [PMID: 35728339 DOI: 10.1016/j.jpsychores.2022.110972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/11/2022] [Accepted: 06/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary aim was to determine the level of stress in Czech pharmacy students using both subjective and physiological markers of stress throughout their study. The secondary aim was to investigate association of stress with sociodemographic and clinical characteristics, and to determine the predictors of the likelihood of enrolling in psychotherapy counselling. METHODS Design: A prospective observational study. SETTING Faculty of Pharmacy in Hradec Kralove, Czech Republic. SUBJECTS 175 s-year pharmacy students in 2016, 149 students in 2017, and 51 students in 2018. OUTCOME MEASURES Perceived stress scale (PSS-10), heart rate variability (HRV, emWavePro), a self-administered survey (sociodemographic and clinical data, likelihood of enrolling in psychotherapy counselling). RESULTS The average PSS score was 18.3 ± 6.7. There were no significant changes in PSS-10 and HRV parameters between 2016 and 2018. There was a significant negative correlation between PSS-10 and LF power (p = 0.012). Female gender and poor health status were more frequently observed among the respondents with impaired HRV (p = 0.026 for female gender and p = 0.025 and p = 0.042 for poor health status). Fifty-nine percent of students would be likely to enroll in psychotherapy counselling, with men being significantly less inclined to participate compared to women (p = 0.01). CONCLUSION Czech pharmacy students experience moderate levels of stress throughout their studies, which correlates with physiological markers of stress as well as their overall health. Push and pull factors of using mind-body interventions to manage stress should be further examined, especially in high risk groups.
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Affiliation(s)
- Katarina Tripska
- The Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, Czech Republic
| | - Jan Draessler
- The Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Kralove, Czech Republic
| | - Jitka Pokladnikova
- The Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Czech Republic.
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Sudden Unexpected Death in Epilepsy. Neurol Int 2022; 14:600-613. [PMID: 35893283 PMCID: PMC9326725 DOI: 10.3390/neurolint14030048] [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: 05/12/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a complex neurological condition with numerous etiologies and treatment options. In a subset of these patients, sudden unexpected death can occur, and to date, there are numerous explanations as to the pathophysiological mechanisms and how to mitigate these catastrophic outcomes. Approximately 2.3 million Americans have epilepsy, and nearly 150,000 people develop the condition each year. Sudden unexpected death in epilepsy (SUDEP) accounts for 2–18% of all epilepsy-related deaths and this is equivalent to one death in 1000 person-years of diagnosed epilepsy. It is more common in young adults aged 20–45. Seizures in the past year; the absence of terminal remission in the last five years; increased seizure frequency, particularly GTCS; and nocturnal seizures are the most potent modifiable risk factors for SUDEP. Patients not receiving any antiepileptic drug therapy are at higher risk of SUDEP. Patient education on medication compliance; care plans for seizure clusters (rescue medicines); epilepsy self-management programs; and lifestyle changes to avoid seizure-triggering factors, including avoiding excessive alcohol use and sleep deprivation, should be provided by health care providers. Continued research into SUDEP will hopefully lead to effective interventions to minimize occurrences. At present, aggressive control of epilepsy and enhanced education for individuals and the public are the most effective weapons for combating SUDEP. This narrative review focuses on updated information related to SUDEP epidemiology; pathophysiology; risk factor treatment options; and finally, a discussion of important clinical studies. We seek to encourage clinicians who care for patients with epilepsy to be aggressive in controlling seizure activity and diligent in their review of risk factors and education of patients and their families about SUDEP.
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Pernice R, Faes L, Feucht M, Benninger F, Mangione S, Schiecke K. Pairwise and higher-order measures of brain-heart interactions in children with temporal lobe epilepsy. J Neural Eng 2022; 19. [PMID: 35803218 DOI: 10.1088/1741-2552/ac7fba] [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: 03/28/2022] [Accepted: 07/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE While it is well-known that epilepsy has a clear impact on the activity of both the central nervous system (CNS) and the autonomic nervous system (ANS), its role on the complex interplay between CNS and ANS has not been fully elucidated yet. In this work, pairwise and higher-order predictability measures based on the concepts of Granger causality (GC) and Partial Information Decomposition (PID) were applied on time series of electroencephalographic (EEG) brain wave amplitude and heart rate variability (HRV) in order to investigate directed brain-heart interactions associated with the occurrence of focal epilepsy. APPROACH HRV and the envelopes of δ and α EEG activity recorded from ipsilateral (ipsi-EEG) and contralateral (contra-EEG) scalp regions were analyzed in 18 children suffering from temporal lobe epilepsy monitored during pre-ictal, ictal and post-ictal periods. After linear parametric model identification, we compared pairwise GC measures computed between HRV and a single EEG component with PID measures quantifying the unique, redundant and synergistic information transferred from ipsi-EEG and contra-EEG to HRV. MAIN RESULTS The analysis of GC revealed a dominance of the information transfer from EEG to HRV and negligible transfer from HRV to EEG, suggesting that CNS activities drive the ANS modulation of the heart rhythm, but did not evidence clear differences between δ and α rhythms, ipsi-EEG and contra-EEG, or pre- and post-ictal periods. On the contrary, PID revealed that epileptic seizures induce a reorganization of the interactions from brain to heart, as the unique predictability of HRV originated from the ipsi-EEG for the δ waves and from the contra-EEG for the α waves in the pre-ictal phase, while these patterns were reversed after the seizure. SIGNIFICANCE These results highlight the importance of considering higher-order interactions elicited by PID for the study of the neuro-autonomic effects of focal epilepsy, and may have neurophysiological and clinical implications.
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Affiliation(s)
- Riccardo Pernice
- Department of Engineering, University of Palermo, Viale delle Scienze, Bldg. 9, Palermo, 90128, ITALY
| | - Luca Faes
- Department of Engineering, University of Palermo, Viale delle Scienze, Bldg. 9, Palermo, 90128, ITALY
| | - Martha Feucht
- Epilepsy Monitoring Unit, Department of Child and Adolenscent Neuropsychiatry, University Hospital Vienna, Währinger Gürtel 18-20, Vienna, 1090, AUSTRIA
| | - Franz Benninger
- Department of Child and Adolescent Medicine, University Hospital Vienna, Währinger Gürtel 18-20, Vienna, 1090, AUSTRIA
| | - Stefano Mangione
- Department of Engineering, University of Palermo, Viale delle Scienze, Bldg. 9, Palermo, Sicilia, 90128, ITALY
| | - Karin Schiecke
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Friedrich Schiller University Jena, Bachstraße 18, Jena, 07743, GERMANY
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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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36
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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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Porto AA, Benjamim CJR, Gonzaga LA, Luciano de Almeida M, Bueno Júnior CR, Garner DM, Valenti VE. Caffeine intake and its influences on heart rate variability recovery in healthy active adults after exercise: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2022; 32:1071-1082. [PMID: 35272883 DOI: 10.1016/j.numecd.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/19/2022]
Abstract
AIMS Results regarding the effects of caffeine (CAF) intake on the autonomic control of heart rate recovery exercise remain inconclusive. Thus far, no study has used effect measures to pool the results of different experiments. We aim to assess the acute effect of CAF intake before exercise on the recovery of heart rate variability (HRV) after exercise through a systematic review and meta-analysis. DATA SYNTHESIS Randomized controlled clinical trials were included; sample composed of physically active or trained adults; CAF should be offered/ingested before exercise, with dosage between 100 and 400 mg or between 2 and 6 mg/kg and administration/ingestion route analogous in the protocols; studies required to present results of HRV indices before and after exercise. Bias risk analysis and meta-analysis were performed. Twelve studies were included in the qualitative synthesis and five studies were encompassed in the quantitative synthesis (meta-analysis). For the Root-mean-square standard deviation (RMSSD) index we revealed p = 0.67, Total 95% confidence interval (95% CI) ranged from -0.45 to 0.29, and 66.7% for heterogeneity between groups were reported. Concerning the High Frequency (HF) index, we observed p = 0.22, Total 95% CI that ranged from -0.34 to 0.30, and 44% for heterogeneity between groups. CONCLUSIONS CAF intake did not affect heart rate variability recovery after exercise.
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Affiliation(s)
- Andrey Alves Porto
- Department of Physical Therapy, Faculty of Sciences and Technologies, UNESP, Presidente Prudente, Brazil; Autonomic Nervous System Center, UNESP, Marilia, SP, Brazil
| | - Cicero Jonas R Benjamim
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Luana Almeida Gonzaga
- Department of Physical Therapy, Faculty of Sciences and Technologies, UNESP, Presidente Prudente, Brazil; Autonomic Nervous System Center, UNESP, Marilia, SP, Brazil
| | | | - Carlos Roberto Bueno Júnior
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil; School of Physical Education of Ribeirão Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - David M Garner
- Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford, OX3 0BP, United Kingdom; Autonomic Nervous System Center, UNESP, Marilia, SP, Brazil
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Hamdy RM, Abdel-Tawab H, Abd Elaziz OH, Sobhy El attar R, Kotb FM. Evaluation of Heart Rate Variability Parameters During Awake and Sleep in Refractory and Controlled Epileptic Patients. Int J Gen Med 2022; 15:3865-3877. [PMID: 35422653 PMCID: PMC9004725 DOI: 10.2147/ijgm.s354895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Rehab M Hamdy
- Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
- Correspondence: Rehab M Hamdy, Department of Cardiology, Faculty for Medicine (for Girls), Al-Azhar University, Cairo, Egypt, Tel +201003022726, Email
| | - Hayam Abdel-Tawab
- Department of Neurology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Ola H Abd Elaziz
- Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Rasha Sobhy El attar
- Department of Neurology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Fatma M Kotb
- Department of Internal Medicine, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
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Halimeh M, Yang Y, Sheehan T, Vieluf S, Jackson M, Loddenkemper T, Meisel C. Wearable device assessments of antiseizure medication effects on diurnal patterns of electrodermal activity, heart rate, and heart rate variability. Epilepsy Behav 2022; 129:108635. [PMID: 35278938 DOI: 10.1016/j.yebeh.2022.108635] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/04/2022] [Accepted: 02/19/2022] [Indexed: 11/03/2022]
Abstract
Patient-generated health data provide a great opportunity for more detailed ambulatory monitoring and more personalized treatments in many diseases. In epilepsy, robust diagnostics applicable to the ambulatory setting are needed as diagnosis and treatment decisions in current clinical practice are primarily reliant on patient self-reports, which are often inaccurate. Recent work using wearable devices has focused on methods to detect and forecast epileptic seizures. Whether wearable device signals may also contain information about the effect of antiseizure medications (ASMs), which may ultimately help to better monitor their efficacy, has not been evaluated yet. Here we systematically investigated the effect of ASMs on different data modalities (electrodermal activity, EDA, heart rate, HR, and heart rate variability, HRV) simultaneously recorded by a wearable device in 48 patients with epilepsy over several days in the epilepsy long-term monitoring unit at a tertiary hospital. All signals exhibited characteristic diurnal variations. HRV, but not HR or EDA-based metrics, were reduced by ASMs. By assessing multiple signals related to the autonomic nervous system simultaneously, our results provide novel insights into the effects of ASMs on the sympathetic and parasympathetic interplay in the setting of epilepsy and indicate the potential of easy-to-wear wearable devices for monitoring ASM action. Future work using longer data may investigate these metrics on multidien cycles and their utility for detecting seizures, assessing seizure risk, or informing treatment interventions.
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Affiliation(s)
- Mustafa Halimeh
- Computational Neurology, Department of Neurology, Charité - Universitätsmedizin Berlin, Germany; Berlin Institute of Health, Germany
| | - Yonghua Yang
- Hospital of Xi'an Jiaotong University, Pediatric Department, Shaanxi, China
| | | | | | | | | | - Christian Meisel
- Computational Neurology, Department of Neurology, Charité - Universitätsmedizin Berlin, Germany; Berlin Institute of Health, Germany.
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Perampanel enhances the cardiovagal tone and heart rate variability (HRV) in patients with drug-resistant temporal lobe epilepsy. Seizure 2022; 99:16-23. [DOI: 10.1016/j.seizure.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
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How predictable is heart rate variability in Brazilian patients with drug-resistant mesial temporal lobe epilepsy? Epilepsy Behav 2022; 128:108532. [PMID: 35101842 DOI: 10.1016/j.yebeh.2021.108532] [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: 10/28/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 11/22/2022]
Abstract
This study aimed to compare heart rate variability (HRV) in patients with drug-resistant mesial temporal lobe epilepsy (MTLE) with healthy controls and to analyze their clinical and sociodemographic variables predictive for HRV. Thirty-nine consecutive patients with drug-resistant MTLE were included in the study. The control group included twenty-seven healthy participants matched by age and gender. Seven HRV indices (HR, RR, rMSSD, SDNN, LF, HF, and LF/HF) were compared between patients and controls. The clinical and sociodemographic variables independently associated with the HRV indices were identified by multiple linear regression. In comparison with controls, the patients with MTLE showed a significant reduction in RR, rMSSD, SDNN, LF, HF, and LF/HF indices (t value 1.97-5.97, p < 0.05). Multiple regression models showed that disease duration predicted 11-22% of the analyzed HRV indices. Time domain indices showed higher association with disease duration than coefficients in frequency domain. Patients with drug-resistant MTLE present cardiac autonomic tone dysfunction, showing a significant reduction in their HRV indices (RR, SDNN, rMSSD, LF, HF, and LF/HF). Disease duration has a negative association with all HRV indices. This study contributes to understanding the relationship between MTLE and the cardiac autonomic tone, with possible implications for sudden unexpected death in epilepsy.
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Dono F, Evangelista G, Consoli S, Scorrano G, Di Pietro M, Vittoria De Angelis M, Faustino M, Franciotti R, Anzellotti F, Onofrj M, Frazzini V, Vollono C, Sensi SL. Heart rate variability is reduced during the menstrual phase in women with catamenial C1-type temporal lobe epilepsy. Epilepsy Behav 2022; 127:108508. [PMID: 34974372 DOI: 10.1016/j.yebeh.2021.108508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Temporal lobe epilepsy (TLE) is the most frequent focal epilepsy in adulthood. Catamenial C1-type TLE, is characterized by a cyclic seizure exacerbation during the menstrual phase. The heart rate variability (HRV) analysis assesses cardiac autonomic control and may represent a biomarker for Sudden Unexpected Death in Epilepsy (SUDEP). It is plausible that female sex hormones can influence HRV. These changes might be more pronounced in patients suffering from catamenial C1-type TLE where hormonal changes also increase seizure susceptibility. To that aim, we evaluated HRV changes during the menstrual phase of women suffering from catamenial C1-type TLE. METHODS We enrolled 12 adults with a diagnosis of catamenial C1-type TLE (Catamenial Group) and 12 age-, and seizure-frequency-matched controls with TLE (Non-Catamenial Group). Each patient underwent a 20-minute EEG + EKG recording in resting state during the menstrual phase. HRV parameters were calculated with a short-lasting analysis of EKG records. Time domain-related, frequency domain-related, as well as non-linear analysis parameters, were compared between the two groups. RESULT Compared to the Non-Catamenial Group, the Catamenial Group showed significant reductions in SDNN (p-value = 0.01), RMSSD (p-value = 0.04), pNN50 (p-value = 0.001), LnLF ms2 (p-value = 0.05), LnHF ms2 (p-value = 0.007), SD1 (p-value = 0.02), and SD2 (p-value = 0.01). These results were independent from age, disease duration, numbers of ASM, and seizure etiology. CONCLUSION Our data provide experimental evidence that vagal output is reduced during the menstrual phase in patients with catamenial C1-type TLE. These results indicate that, during the menstrual phase, patients with catamenial C1-type TLE may be at a higher risk of developing cardiac dysfunctions and SUDEP.
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Affiliation(s)
- Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giovanna Scorrano
- Department of Pediatrics, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | | | | | - Raffaella Franciotti
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesca Anzellotti
- Department of Neurology, Epilepsy Center, "SS Annunziata" Hospital, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Valerio Frazzini
- Brain and Spine Institute (INSERM UMRS1127, CNRS UMR7225, Sorbonne Université), Pitié-Salpêtrière Hospital, Paris, Italy; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Italy
| | - Catello Vollono
- Department of Geriatrics, Neurosciences & Orthopedics Unit of Neurophysiopathology, IRCCS Policlinico Universitario Agostino Gemelli Catholic University, Rome, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; Departments of Neurology and Pharmacology, Institute for Mind Impairments and Neurological Disorders - iMIND, University of California - Irvine, Irvine, USA.
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Abstract
Much of biology is rhythmical and comprises oscillators that can couple. These have optimized energy efficiency and have been preserved during evolution. The respiratory and cardiovascular systems contain numerous oscillators, and importantly, they couple. This coupling is dynamic but essential for an efficient transmission of neural information critical for the precise linking of breathing and oxygen delivery while permitting adaptive responses to changes in state. The respiratory pattern generator and the neural network responsible for sympathetic and cardiovagal (parasympathetic) tone generation interact at many levels ensuring that cardiac output and regional blood flow match oxygen delivery to the lungs and tissues efficiently. The most classic manifestations of these interactions are respiratory sinus arrhythmia and the respiratory modulation of sympathetic nerve activity. These interactions derive from shared somatic and cardiopulmonary afferent inputs, reciprocal interactions between brainstem networks and inputs from supra-pontine regions. Disrupted respiratory-cardiovascular coupling can result in disease, where it may further the pathophysiological sequelae and be a harbinger of poor outcomes. This has been well documented by diminished respiratory sinus arrhythmia and altered respiratory sympathetic coupling in animal models and/or patients with myocardial infarction, heart failure, diabetes mellitus, and neurological disorders as stroke, brain trauma, Parkinson disease, or epilepsy. Future research needs to assess the therapeutic potential for ameliorating respiratory-cardiovascular coupling in disease.
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Affiliation(s)
- James P Fisher
- Manaaki Manawa-The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tymoteusz Zera
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Julian F R Paton
- Manaaki Manawa-The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
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Zhuravlev D, Lebedeva A, Lebedeva M, Guekht A. Current concepts about autonomic dysfunction in patients with epilepsy. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:131-138. [DOI: 10.17116/jnevro2022122031131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Bassi TG, Rohrs EC, Fernandez KC, Ornowska M, Nicholas M, Gani M, Evans D, Reynolds SC. Transvenous Diaphragm Neurostimulation Mitigates Ventilation-associated Brain Injury. Am J Respir Crit Care Med 2021; 204:1391-1402. [PMID: 34491883 PMCID: PMC8865722 DOI: 10.1164/rccm.202101-0076oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Mechanical ventilation (MV) is associated with hippocampal apoptosis and inflammation, and it is important to study strategies to mitigate them. Objectives: To explore whether temporary transvenous diaphragm neurostimulation (TTDN) in association with MV mitigates hippocampal apoptosis and inflammation after 50 hours of MV. Methods: Normal-lung porcine study comparing apoptotic index, inflammatory markers, and neurological-damage serum markers between never-ventilated subjects, subjects undergoing 50 hours of MV plus either TTDN every other breath or every breath, and subjects undergoing 50 hours of MV (MV group). MV settings in volume control were Vt of 8 ml/kg, and positive end-expiratory pressure of 5 cm H2O. Measurements and Main Results: Apoptotic indices, microglia percentages, and reactive astrocyte percentages were greater in the MV group in comparison with the other groups (P < 0.05). Transpulmonary pressure at baseline and at study end were both lower in the group receiving TTDN every breath, but lung injury scores and systemic inflammatory markers were not different between the groups. Serum concentrations of four neurological-damage markers were lower in the group receiving TTDN every breath than in the MV group (P < 0.05). Heart rate variability declined significantly in the MV group and increased significantly in both TTDN groups over the course of the experiments. Conclusions: Our study found that mechanical ventilation is associated with hippocampal apoptosis and inflammation, independent of lung injury and systemic inflammation. Also, in a porcine model, TTDN results in neuroprotection after 50 hours, and the degree of neuroprotection increases with greater exposure to TTDN.
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Affiliation(s)
- Thiago G. Bassi
- Simon Fraser University, Burnaby, British Columbia, Canada
- Lungpacer Medical Inc., Vancouver, British Columbia, Canada; and
| | - Elizabeth C. Rohrs
- Simon Fraser University, Burnaby, British Columbia, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Karl C. Fernandez
- Simon Fraser University, Burnaby, British Columbia, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | - Michelle Nicholas
- Simon Fraser University, Burnaby, British Columbia, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Matt Gani
- Lungpacer Medical Inc., Vancouver, British Columbia, Canada; and
| | - Doug Evans
- Lungpacer Medical Inc., Vancouver, British Columbia, Canada; and
| | - Steven C. Reynolds
- Simon Fraser University, Burnaby, British Columbia, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
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Berg AT, Coffman K, Gaebler-Spira D. Dysautonomia and functional impairment in rare developmental and epileptic encephalopathies: the other nervous system. Dev Med Child Neurol 2021; 63:1433-1440. [PMID: 34247387 DOI: 10.1111/dmcn.14990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/27/2022]
Abstract
AIM To determine whether functional impairments and autonomic symptoms are correlated in young people with developmental and epileptic encephalopathies (DEEs). METHOD Cross-sectional, online surveys (2018-2020) of parents recruited from family groups obtained information on several aspects of children's conditions including functional abilities (mobility, hand use, eating, and communication), 18 autonomic symptoms in six groups (cardiac, respiratory, sweating, temperature, gastrointestinal, and other), and parental stress. Bivariate and multivariable logistic regression analyses examined associations of dysautonomias with functional impairment, adjusted for type of DEE and age. RESULTS Of 313 participants with full information on function and dysautonomias, 156 (50%) were females. The median age was 8 years (interquartile range 4-12y); 255 (81%) participants had symptoms in at least one autonomic symptom group; 283 (90%) had impairment in at least one functional domain. The number of functional impairment domains and of autonomic symptom groups varied significantly across DEE groups (both p<0.001). The number of functional impairment domains and of autonomic symptom groups were correlated (Spearman's r=0.35, p<0.001) on bivariate and multivariable analysis adjusted for DEE group and age. Parental stress was also independently correlated with dysautonomias (p<0.001). INTERPRETATION Parent-reported dysautonomias are common in children with DEEs. They correlate with extent of functional impairment and may contribute to caregiver stress. What this paper adds Dysautonomic symptoms are common in young people with developmental and epileptic encephalopathies (DEEs). Burden of dysautonomias is strongly correlated with burden of functional impairments. Aspects of dysautonomic function may provide biomarkers of DEE disease severity.
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Affiliation(s)
- Anne T Berg
- Division of Neurology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Keith Coffman
- Division of Neurology, Department of Pediatrics, Children's Mercy, Kansas City, MO, USA
| | - Deborah Gaebler-Spira
- Shirley Ryan Ability Lab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Heart rate variability in patients with refractory epilepsy: The influence of generalized convulsive seizures. Epilepsy Res 2021; 178:106796. [PMID: 34763267 DOI: 10.1016/j.eplepsyres.2021.106796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Patients with epilepsy, mainly drug-resistant, have reduced heart rate variability (HRV), linked to an increased risk of sudden death in various other diseases. In this context, it could play a role in SUDEP. Generalized convulsive seizures (GCS) are one of the most consensual risk factors for SUDEP. Our objective was to assess the influence of GCS in HRV parameters in patients with drug-resistant epilepsy. METHODS We prospectively evaluated 121 patients with refractory epilepsy admitted to our Epilepsy Monitoring Unit. All patients underwent a 48-hour Holter recording. Only patients with GCS were included (n = 23), and we selected the first as the index seizure. We evaluated HRV (AVNN, SDNN, RMSSD, pNN50, LF, HF, and LF/HF) in 5-min epochs (diurnal and nocturnal baselines; preictal - 5 min before the seizure; ictal; postictal - 5 min after the seizure; and late postictal - >5 h after the seizure). These data were also compared with normative values from a healthy population (controlling for age and gender). RESULTS We included 23 patients, with a median age of 36 (min-max, 16-55) years and 65% were female. Thirty percent had cardiovascular risk factors, but no previously known cardiac disease. HRV parameters AVNN, RMSSD, pNN50, and HF were significantly lower in the diurnal than in the nocturnal baseline, whereas the opposite occurred with LF/HF and HR. Diurnal baseline parameters were inferior to the normative population values (which includes only diurnal values). We found significant differences in HRV parameters between the analyzed periods, especially during the postictal period. All parameters but LF/HF suffered a reduction in that period. LF/HF increased in that period but did not reach statistical significance. Visually, there was a tendency for a global reduction in our patients' HRV parameters, namely AVNN, RMSSD, and pNN50, in each period, comparing with those from a normative healthy population. No significant differences were found in HRV between diurnal and nocturnal seizures, between temporal lobe and extra-temporal-lobe seizures, between seizures with and without postictal generalized EEG suppression, or between seizures of patients with and without cardiovascular risk factors. SIGNIFICANCE/CONCLUSION Our work reinforces the evidence of autonomic cardiac dysfunction in patients with refractory epilepsy, at baseline and mainly in the postictal phase of a GCS. Those changes may have a role in some SUDEP cases. By identifying patients with worse autonomic cardiac function, HRV could fill the gap of a lacking SUDEP risk biomarker.
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Martins DF, Viseux FJF, Salm DC, Ribeiro ACA, da Silva HKL, Seim LA, Bittencourt EB, Bianco G, Moré AOO, Reed WR, Mazzardo-Martins L. The role of the vagus nerve in fibromyalgia syndrome. Neurosci Biobehav Rev 2021; 131:1136-1149. [PMID: 34710514 DOI: 10.1016/j.neubiorev.2021.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/08/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022]
Abstract
Fibromyalgia (FM) syndrome is a common illness characterized by chronic widespread pain, sleep problems, fatigue, and cognitive difficulties. Dysfunctional neurotransmitter systems that influence the body's endogenous stress response systems are thought to underlie many of the major FM-related symptoms. A model of FM pathogenesis suggests biological and psychosocial variables interact to influence the genetic predisposition, but the precise mechanisms remain unclear. The Polyvagal Theory provides a theoretical framework from which to investigate potential biological mechanisms. The vagus nerve (VN) has anti-inflammatory properties via its afferent and efferent fibers. A low vagal tone (as assessed by low heart rate variability), has been observed in painful and inflammatory diseases, including FM, while the ventral branch of the VN is linked to emotional expression and social engagement. These anti-inflammatory and psychological (limbic system) properties of the VN may possess therapeutic potential in treating FM. This review paper summarizes the scientific literature regarding the potential role of the VN in transducing and/or therapeutically managing FM signs and symptoms.
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Affiliation(s)
- Daniel F Martins
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil.
| | - Frederic J F Viseux
- Laboratoire d'Automatique, de Mécanique et d'Informatique industrielle et Humaine (LAMIH), UMR CNRS 8201, Université Polytechnique des Hauts-de-France, Valenciennes, France; Centre d'Evaluation et de Traitement de la Douleur (CETD), Hôpital Jean Bernard, Centre Hospitalier de Valenciennes, F-59322 Valenciennes, France
| | - Daiana C Salm
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Anny Caroline Avelino Ribeiro
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Helen Kassiana Lopes da Silva
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Lynsey A Seim
- Hospital Internal Medicine, 4500 San Pablo Road, Mayo Clinic, Jacksonville, FL, USA
| | | | - Gianluca Bianco
- Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, Rome, Italy; Istituto di Formazione in Agopuntura e Neuromodulazione IFAN, Rome, Italy
| | - Ari Ojeda Ocampo Moré
- Integrative Medicine and Acupuncture Service, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - William R Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leidiane Mazzardo-Martins
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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50
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Wu ML, Hu DM, Wang JJ, Liu XL, Liu L, Li Y, Jing W. Pre- and postoperative heart rate variability and vagus nerve stimulation in patients with drug-resistant epilepsy - A meta-analysis. Epilepsy Behav 2021; 123:108247. [PMID: 34418640 DOI: 10.1016/j.yebeh.2021.108247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The effect of vagus nerve stimulation (VNS), an important auxiliary therapy for treating drug-resistant epilepsy (DRE), on autonomic nerve function is still controversial. Heart rate variability is a widely used indicator of autonomic nerve function. To clarify the relationship between VNS and heart rate variability (HRV), we performed a meta-analysis to systematically evaluate the effect of VNS on HRV in patients with epilepsy. METHODS We performed a systematic review by searching the following online databases: PubMed, Web of Science, EMBASE and the Cochrane Library. The key search terms were "vagal nerve stimulation," "epilepsy" and "heart rate variability". Other features of VNS in patients with epilepsy include postoperative changes in low-frequency (LF), high-frequency (HF) and low-frequency/high-frequency (LF/HF) heart rate variability, which were used as evaluation indices, and the Newcastle-Ottawa Quality Assessment Scale and Stata 14.0 statistical software were used for literature quality evaluation and meta-analysis. RESULTS Twelve studies published in English were obtained, and 229 patients with epilepsy who underwent VNS were ultimately included after elimination of duplicate articles and those that did not meet the inclusion criteria. Regarding LF heart rate variability, in the response subgroup, patients with DRE with VNS presented a lower value (-0.58) before surgery than after surgery, with a 95% confidence interval (CI) ranging from -1.00 to -0.15. For HF heart rate variability, patients with DRE with VNS had a lower value (-0.45) before surgery than after surgery in the response subgroup, with a 95% CI ranging from -0.74 to -0.17. No differences were found for LF/HF values or the LF and HF values of other subgroups. CONCLUSION VNS has little effect on the balance of sympathetic and parasympathetic nerve activity and would not be expected to cause cardiovascular autonomic dysfunction in patients with DRE. For patients with DRE, VNS can control seizures and has little effect on autonomic nervous function.
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Affiliation(s)
- Mao-Lin Wu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, Shanxi, China
| | - Dan-Mei Hu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, Shanxi, China
| | | | - Xiao-Lei Liu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, Shanxi, China
| | - Lei Liu
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Yuan Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China.
| | - Wei Jing
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, Shanxi, China.
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