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Hagiwara K. [Insular lobe epilepsy. Part 1: semiology]. Rinsho Shinkeigaku 2024:cn-001930-1. [PMID: 39069491 DOI: 10.5692/clinicalneurol.cn-001930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
The insula is often referred to as "the fifth lobe" of the brain, and its accessibility used to be very limited due to the deep location under the opercula as well as the sylvian vasculature. It was not until the availability of modern stereo-electroencephalography (SEEG) technique that the intracranial electrodes could be safely and chronically implanted within the insula, thereby enabling anatomo-electro-clinical correlations in seizures of this deep origin. Since the first report of SEEG-recorded insular seizures in late 1990s, the knowledge of insular lobe epilepsy (ILE) has rapidly expanded. Being on the frontline for the diagnosis and management of epilepsy, neurologists should have a precise understanding of ILE to differentiate it from epilepsies of other lobes or non-epileptic conditions. Owing to the multimodal nature and rich anatomo-functional connections of the insula, ILE has a wide range of clinical presentations. The following symptoms should heighten the suspicion of ILE: somatosensory symptoms involving a large/bilateral cutaneous territory or taking on thermal/painful character, and cervico-laryngeal discomfort. The latter ranges from slight dyspnea to a strong sensation of strangulation (laryngeal constriction). Other symptoms include epigastric discomfort/nausea, hypersalivation, auditory, vestibular, gustatory, and aphasic symptoms. However, most of these insulo-opercular symptoms can easily be masked by those of extra-insular seizure propagation. Indeed, sleep-related hyperkinetic (hypermotor) epilepsy (SHE) is a common clinical presentation of ILE, which shows predominant hyperkinetic and/or tonic-dystonic features that are often indistinguishable from those of fronto-mesial seizures. Subtle objective signs, such as constrictive throat noise (i.e., laryngeal constriction) or aversive behavior (e.g., facial grimacing suggesting pain), are often the sole clue in diagnosing insular SHE. Insular-origin seizures should also be considered in temporal-like seizures without frank anatomo-electro-clinical correlations. All in all, ILE is not the epilepsy of an isolated island but rather of a crucial hub involved in the multifaceted roles of the brain.
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Salazar Serrano G, Dias de Oliveira A, Miotto R, Lin K, Loureiro Fialho G. Aborted sudden cardiac death in a young patient with epilepsy and the Gorlin Goltz syndrome. Epilepsy Behav Rep 2024; 26:100667. [PMID: 38699063 PMCID: PMC11063993 DOI: 10.1016/j.ebr.2024.100667] [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 one of the most common chronical neurological conditions affecting over 50 million people worldwide. In addition to the stigma and discrimination, individuals with epilepsy suffer from a nearly three-fold increased risk of premature death compared to the general population. Although these premature deaths occur due to multiple causes, sudden unexpected death in epilepsy (SUDEP) still challenges neurologists and clinicians dealing with individuals with epilepsy. Recently, an increased interest in cardiac outcomes related to acute seizures and chronic epilepsy resulted in the groundbreaking development of the "epileptic heart" concept, and sudden cardiac death in individuals with epilepsy, which is 4.5 times as frequent as SUDEP according to some observational data, has gained more attention. As we gather information and learn about possible comorbidities and consequences of seizures and/or chronic epilepsy, we present a clinical case of a young patient with an unusual association of epilepsy, the Gorlin Goltz syndrome, and a cardiac fibroma with Wolf-Parkinson-White (WPW), who had multiple aborted cardiac arrests. Diagnostic challenges and multiple possible causes of sudden cardiac death in this single patient report are discussed.
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Affiliation(s)
- Guilherme Salazar Serrano
- Department of Internal Medicine, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | - Ramsés Miotto
- Cardiology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil
| | - Katia Lin
- Center for Applied Neuroscience, HU, UFSC, Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil
- Post-Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), HU, UFSC, Florianópolis, SC, Brazil
| | - Guilherme Loureiro Fialho
- Cardiology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil
- Center for Applied Neuroscience, HU, UFSC, Florianópolis, SC, Brazil
- Post-Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
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Ricordeau F, Chouchou F, Pichot V, Roche F, Petitjean T, Gormand F, Bastuji H, Charbonnier E, Le Cam P, Stauffer E, Rheims S, Peter-Derex L. Impaired post-sleep apnea autonomic arousals in patients with drug-resistant epilepsy. Clin Neurophysiol 2024; 160:1-11. [PMID: 38367308 DOI: 10.1016/j.clinph.2024.02.003] [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: 09/09/2023] [Revised: 12/20/2023] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Sudden and unexpected deaths in epilepsy (SUDEP) pathophysiology may involve an interaction between respiratory dysfunction and sleep/wake state regulation. We investigated whether patients with epilepsy exhibit impaired sleep apnea-related arousals. METHODS Patients with drug-resistant (N = 20) or drug-sensitive (N = 20) epilepsy and obstructive sleep apnea, as well as patients with sleep apnea but without epilepsy (controls, N = 20) were included. We explored (1) the respiratory arousal threshold based on nadir oxygen saturation, apnea-hypopnea index, and fraction of hypopnea among respiratory events; (2) the cardiac autonomic response to apnea/hypopnea quantified as percentages of changes from the baseline in RR intervals (RRI), high (HF) and low (LF) frequency powers, and LF/HF. RESULTS The respiratory arousal threshold did not differ between groups. At arousal onset, RRI decreased (-9.42%) and LF power (179%) and LF/HF ratio (190%) increased. This was followed by an increase in HF power (118%), p < 0.05. The RRI decrease was lower in drug-resistant (-7.40%) than in drug-sensitive patients (-9.94%) and controls (-10.91%), p < 0.05. LF and HF power increases were higher in drug-resistant (188%/126%) than in drug-sensitive patients (172%/126%) and controls (177%/115%), p < 0.05. CONCLUSIONS Cardiac reactivity following sleep apnea is impaired in drug-resistant epilepsy. SIGNIFICANCE This autonomic dysfunction might contribute to SUDEP pathophysiology.
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Affiliation(s)
- François Ricordeau
- Centre for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon, France; Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - Florian Chouchou
- IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, Le Tampon, France
| | - Vincent Pichot
- SAINBIOSE, INSERM U1059, Saint-Etienne Jean-Monnet University, Mines Saint-Etienne, France; Clinical Physiology and Exercise, Visas Center, Saint Etienne University Hospital, France
| | - Frédéric Roche
- SAINBIOSE, INSERM U1059, Saint-Etienne Jean-Monnet University, Mines Saint-Etienne, France; Clinical Physiology and Exercise, Visas Center, Saint Etienne University Hospital, France
| | - Thierry Petitjean
- Centre for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Gormand
- Centre for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon, France
| | - Hélène Bastuji
- Centre for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, CNRS UMR 5292 / INSERM U1028 and Lyon 1 University, Lyon, France
| | - Eléna Charbonnier
- Centre for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon, France
| | - Pierre Le Cam
- Centre for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon, France
| | - Emeric Stauffer
- Centre for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon, France; Inter-university Laboratoryof Human MovementBiology (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Lyon 1 University, Lyon, France; Respiratory Functional Investigation & Physical Activity Department, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, CNRS UMR 5292 / INSERM U1028 and Lyon 1 University, Lyon, France; Lyon 1 University, Lyon, France
| | - Laure Peter-Derex
- Centre for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, CNRS UMR 5292 / INSERM U1028 and Lyon 1 University, Lyon, France; Lyon 1 University, Lyon, France.
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Mason F, Scarabello A, Taruffi L, Pasini E, Calandra-Buonaura G, Vignatelli L, Bisulli F. Heart Rate Variability as a Tool for Seizure Prediction: A Scoping Review. J Clin Med 2024; 13:747. [PMID: 38337440 PMCID: PMC10856437 DOI: 10.3390/jcm13030747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The most critical burden for People with Epilepsy (PwE) is represented by seizures, the unpredictability of which severely impacts quality of life. The design of real-time warning systems that can detect or even predict ictal events would enhance seizure management, leading to high benefits for PwE and their caregivers. In the past, various research works highlighted that seizure onset is anticipated by significant changes in autonomic cardiac control, which can be assessed through heart rate variability (HRV). This manuscript conducted a scoping review of the literature analyzing HRV-based methods for detecting or predicting ictal events. An initial search on the PubMed database returned 402 papers, 72 of which met the inclusion criteria and were included in the review. These results suggest that seizure detection is more accurate in neonatal and pediatric patients due to more significant autonomic modifications during the ictal transitions. In addition, conventional metrics are often incapable of capturing cardiac autonomic variations and should be replaced with more advanced methodologies, considering non-linear HRV features and machine learning tools for processing them. Finally, studies investigating wearable systems for heart monitoring denoted how HRV constitutes an efficient biomarker for seizure detection in patients presenting significant alterations in autonomic cardiac control during ictal events.
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Affiliation(s)
- Federico Mason
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Anna Scarabello
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Lisa Taruffi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
| | - Elena Pasini
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Luca Vignatelli
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (F.M.); (A.S.); (L.T.); (G.C.-B.); (F.B.)
- IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE, 40139 Bologna, Italy;
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Senapati SG, Bhanushali AK, Lahori S, Naagendran MS, Sriram S, Ganguly A, Pusa M, Damani DN, Kulkarni K, Arunachalam SP. Mapping of Neuro-Cardiac Electrophysiology: Interlinking Epilepsy and Arrhythmia. J Cardiovasc Dev Dis 2023; 10:433. [PMID: 37887880 PMCID: PMC10607576 DOI: 10.3390/jcdd10100433] [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: 07/16/2023] [Revised: 08/10/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
The interplay between neurology and cardiology has gained significant attention in recent years, particularly regarding the shared pathophysiological mechanisms and clinical comorbidities observed in epilepsy and arrhythmias. Neuro-cardiac electrophysiology mapping involves the comprehensive assessment of both neural and cardiac electrical activity, aiming to unravel the intricate connections and potential cross-talk between the brain and the heart. The emergence of artificial intelligence (AI) has revolutionized the field by enabling the analysis of large-scale data sets, complex signal processing, and predictive modeling. AI algorithms have been applied to neuroimaging, electroencephalography (EEG), electrocardiography (ECG), and other diagnostic modalities to identify subtle patterns, classify disease subtypes, predict outcomes, and guide personalized treatment strategies. In this review, we highlight the potential clinical implications of neuro-cardiac mapping and AI in the management of epilepsy and arrhythmias. We address the challenges and limitations associated with these approaches, including data quality, interpretability, and ethical considerations. Further research and collaboration between neurologists, cardiologists, and AI experts are needed to fully unlock the potential of this interdisciplinary field.
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Affiliation(s)
- Sidhartha G. Senapati
- Department of Internal Medicine, Texas Tech University Health and Sciences Center, El Paso, TX 79905, USA; (S.G.S.); (D.N.D.)
| | - Aditi K. Bhanushali
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (A.K.B.); (S.L.)
| | - Simmy Lahori
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (A.K.B.); (S.L.)
| | | | - Shreya Sriram
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Arghyadeep Ganguly
- Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49007, USA;
| | - Mounika Pusa
- Mamata Medical College, Khammam 507002, Telangana, India;
| | - Devanshi N. Damani
- Department of Internal Medicine, Texas Tech University Health and Sciences Center, El Paso, TX 79905, USA; (S.G.S.); (D.N.D.)
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kanchan Kulkarni
- IHU-LIRYC, Heart Rhythm Disease Institute, Fondation Bordeaux Université, Pessac, 33600 Bordeaux, France;
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, U1045, 33000 Bordeaux, France
| | - Shivaram P. Arunachalam
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (A.K.B.); (S.L.)
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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You SM, Cho BH, Bae HE, Kim YK, Kim JR, Park SR, Shon YM, Seo DW, Kim IY. Exploring Autonomic Alterations during Seizures in Temporal Lobe Epilepsy: Insights from a Heart-Rate Variability Analysis. J Clin Med 2023; 12:4284. [PMID: 37445319 DOI: 10.3390/jcm12134284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Epilepsy's impact on cardiovascular function and autonomic regulation, including heart-rate variability, is complex and may contribute to sudden unexpected death in epilepsy (SUDEP). Lateralization of autonomic control in the brain remains the subject of debate; nevertheless, ultra-short-term heart-rate variability (HRV) analysis is a useful tool for understanding the pathophysiology of autonomic dysfunction in epilepsy patients. A retrospective study reviewed medical records of patients with temporal lobe epilepsy who underwent presurgical evaluations. Data from 75 patients were analyzed and HRV indices were extracted from electrocardiogram recordings of preictal, ictal, and postictal intervals. Various HRV indices were calculated, including time domain, frequency domain, and nonlinear indices, to assess autonomic function during different seizure intervals. The study found significant differences in HRV indices based on hemispheric laterality, language dominancy, hippocampal atrophy, amygdala enlargement, sustained theta activity, and seizure frequency. HRV indices such as the root mean square of successive differences between heartbeats, pNN50, normalized low-frequency, normalized high-frequency, and the low-frequency/high-frequency ratio exhibited significant differences during the ictal period. Language dominancy, hippocampal atrophy, amygdala enlargement, and sustained theta activity were also found to affect HRV. Seizure frequency was correlated with HRV indices, suggesting a potential relationship with the risk of SUDEP.
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Affiliation(s)
- Sung-Min You
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Republic of Korea
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Baek-Hwan Cho
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Republic of Korea
- Institute of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Republic of Korea
| | - Hyo-Eun Bae
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Young-Kyun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jae-Rim Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Soo-Ryun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Young-Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - In-Young Kim
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Republic of Korea
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Faingold CL, Feng HJ. A unified hypothesis of SUDEP: Seizure-induced respiratory depression induced by adenosine may lead to SUDEP but can be prevented by autoresuscitation and other restorative respiratory response mechanisms mediated by the action of serotonin on the periaqueductal gray. Epilepsia 2023; 64:779-796. [PMID: 36715572 PMCID: PMC10673689 DOI: 10.1111/epi.17521] [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: 10/07/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a major cause of death in people with epilepsy (PWE). Postictal apnea leading to cardiac arrest is the most common sequence of terminal events in witnessed cases of SUDEP, and postconvulsive central apnea has been proposed as a potential biomarker of SUDEP susceptibility. Research in SUDEP animal models has led to the serotonin and adenosine hypotheses of SUDEP. These neurotransmitters influence respiration, seizures, and lethality in animal models of SUDEP, and are implicated in human SUDEP cases. Adenosine released during seizures is proposed to be an important seizure termination mechanism. However, adenosine also depresses respiration, and this effect is mediated, in part, by inhibition of neuronal activity in subcortical structures that modulate respiration, including the periaqueductal gray (PAG). Drugs that enhance the action of adenosine increase postictal death in SUDEP models. Serotonin is also released during seizures, but enhances respiration in response to an elevated carbon dioxide level, which often occurs postictally. This effect of serotonin can potentially compensate, in part, for the adenosine-mediated respiratory depression, acting to facilitate autoresuscitation and other restorative respiratory response mechanisms. A number of drugs that enhance the action of serotonin prevent postictal death in several SUDEP models and reduce postictal respiratory depression in PWE. This effect of serotonergic drugs may be mediated, in part, by actions on brainstem sites that modulate respiration, including the PAG. Enhanced activity in the PAG increases respiration in response to hypoxia and other exigent conditions and can be activated by electrical stimulation. Thus, we propose the unifying hypothesis that seizure-induced adenosine release leads to respiratory depression. This can be reversed by serotonergic action on autoresuscitation and other restorative respiratory responses acting, in part, via the PAG. Therefore, we hypothesize that serotonergic or direct activation of this brainstem site may be a useful approach for SUDEP prevention.
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Affiliation(s)
- Carl L Faingold
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Hua-Jun Feng
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA
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Karasmanoglou A, Antonakakis M, Zervakis M. ECG-Based Semi-Supervised Anomaly Detection for Early Detection and Monitoring of Epileptic Seizures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5000. [PMID: 36981911 PMCID: PMC10049350 DOI: 10.3390/ijerph20065000] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Epilepsy is one of the most common brain diseases, characterized by frequent recurrent seizures or "ictal" states. A patient experiences uncontrollable muscular contractions, inducing loss of mobility and balance, which may result in injury or even death during these ictal states. Extensive investigation is vital to establish a systematic approach for predicting and informing patients about oncoming seizures ahead of time. Most methodologies developed are focused on the detection of abnormalities using mostly electroencephalogram (EEG) recordings. In this regard, research has indicated that certain pre-ictal alterations in the Autonomic Nervous System (ANS) can be detected in patient electrocardiogram (ECG) signals. The latter could potentially provide the basis for a robust seizure prediction approach. The recently proposed ECG-based seizure warning systems utilize machine learning models to classify a patient's condition. Such approaches require the incorporation of large, diverse, and thoroughly annotated ECG datasets, limiting their application potential. In this work, we investigate anomaly detection models in a patient-specific context with low supervision requirements. Specifically, we consider One-Class SVM (OCSVM), Minimum Covariance Determinant (MCD) Estimator, and Local Outlier Factor (LOF) models to quantify the novelty or abnormality of pre-ictal short-term (2-3 min) Heart Rate Variability (HRV) features of patients, trained on a reference interval considered to contain stable heart rate as the only form of supervision. Our models are evaluated against labels that were either hand-picked or automatically generated (weak labels) by a two-phase clustering procedure for samples of the "Post-Ictal Heart Rate Oscillations in Partial Epilepsy" (PIHROPE) dataset recorded by the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, achieving detection in 9 out of 10 cases, with average AUCs of over 93% across all models and warning times ranging from 6 to 30 min prior to seizure. The proposed anomaly detection and monitoring approach can potentially pave the way for early detection and warning of seizure incidents based on body sensor inputs.
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Assessing epilepsy-related autonomic manifestations: Beyond cardiac and respiratory investigations. Neurophysiol Clin 2023; 53:102850. [PMID: 36913775 DOI: 10.1016/j.neucli.2023.102850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/13/2023] Open
Abstract
The Autonomic Nervous System (ANS) regulates many critical physiological functions. Its control relies on cortical input, especially limbic areas, which are often involved in epilepsy. Peri-ictal autonomic dysfunction is now well documented, but inter-ictal dysregulation is less studied. In this review, we discuss the available data on epilepsy-related autonomic dysfunction and the objective tests available. Epilepsy is associated with sympathetic-parasympathetic imbalance and a shift towards sympathetic dominance. Objective tests report alterations in heart rate, baroreflex function, cerebral autoregulation, sweat glands activity, thermoregulation, gastrointestinal and urinary function. However, some tests have found contradictory results and many tests suffer from a lack of sensitivity and reproducibility. Further study on interictal ANS function is required to further understand autonomic dysregulation and the potential association with clinically-relevant complications, including risk of Sudden Unexpected Death In Epilepsy (SUDEP).
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Central control of cardiac activity as assessed by intra-cerebral recordings and stimulations. Neurophysiol Clin 2023; 53:102849. [PMID: 36867969 DOI: 10.1016/j.neucli.2023.102849] [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: 01/26/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Some of the most important integrative control centers for the autonomic nervous system are located in the brainstem and the hypothalamus. However, growing recent neuroimaging evidence support that a set of cortical regions, named the central autonomic network (CAN), is involved in autonomic control and seems to play a major role in continuous autonomic cardiac adjustments to high-level emotional, cognitive or sensorimotor cortical activities. Intracranial explorations during stereo-electroencephalography (SEEG) offer a unique opportunity to address the question of the brain regions involved in heart-brain interaction, by studying: (i) direct cardiac effects produced by the electrical stimulation of specific brain areas; (ii) epileptic seizures inducing cardiac modifications; (iii) cortical regions involved in cardiac interoception and source of cardiac evoked potentials. In this review, we detail the available data assessing cardiac central autonomic regulation using SEEG, address the strengths and also the limitations of this technique in this context, and discuss perspectives. The main cortical regions that emerge from SEEG studies as being involved in cardiac autonomic control are the insula and regions belonging to the limbic system: the amygdala, the hippocampus, and the anterior and mid-cingulate. Although many questions remain, SEEG studies have already demonstrated afferent and efferent interactions between the CAN and the heart. Future studies in SEEG should integrate these afferent and efferent dimensions as well as their interaction with other cortical networks to better understand the functional heart-brain interaction.
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Evaluation of autonomic nervous system functions by using tilt table test and heart rate variability in epileptic children. MARMARA MEDICAL JOURNAL 2023. [DOI: 10.5472/marumj.1244552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: The value of head-up tilt test (HUTT) for differential diagnosis of epilepsy and the autonomic nervous system functions in
epileptic children using heart rate variability (HRV) are studied.
Patients and Methods: The study group consisted of 16 children with idiopatic/criptogenic epilepsy and 12 controls. Heart rate, PR
interval, corrected QT (QTc) interval, QT and QTc dispersion were calculated using 12-lead electrocardiogram (ECG), HRV analysis
was performed using the Holter recordings obtained both during HUTT and throughout the day. Time domain parameters, standard
deviation of all RR intervals (SDNN), the standard deviation of mean NN intervals in five-minutes recording (SDANN), mean standard
deviation of NN intervals in five-minutes recordings (SDNNi), root mean square of successive differences (RMSSD), count divided
by the total number of all NN intervals (pNN50) and frequency domain parameters low frequency (LF), high frequency (HF), lowfrequency/
high-frequency ratio (LF/HF) were calculated in both and compared between the two groups.
Results: Head-up tilt test was positive in 4 epileptic children (25%), none of controls were positive. The heart rate of the patients were
higher than the controls (p=0.015). LF/HF ratio in 24-hour Holter recordings, were significantly lower (1.13±0.6, 1.83±0.7 respectively,
p=0.002); the SDANN during HUTT (28.7±20.2, 18.2 ± 19.9 respectively, p=0.024) were significantly higher in the patients than the
controls.
Conclusion: Head-up tilt test positivity is frequent in epileptic children, and cannot be used in differential diagnosis. HRV calculated
both from 24 hour Holter recordings and Holter recordings under orthostatic stress were impaired in favour of parasympathetic
system in epileptic children.
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12
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Reevaluation of risk factors for aneurysmal subarachnoid hemorrhage associated epilepsy. J Neurol Sci 2023; 444:120519. [PMID: 36563606 DOI: 10.1016/j.jns.2022.120519] [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: 09/15/2022] [Revised: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Symptomatic epilepsy is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) associated with poor outcome. We sought to analyze the risk factors leading to post-SAH epilepsy. METHODS All consecutive aSAH cases treated between 01/2003 and 06/2016 were retrospectively included. Post-aSAH period was followed up to 03/2020 for the occurrence of epilepsy. Demographic characteristics and previous medical history of the patients, parameters of initial severity, performed treatments, certain early and late complications of aSAH, as well as routine laboratory and vital parameter measurements were collected. Functional outcome was assessed at discharge and 6 months after aSAH using the modified Rankin scale (mRS). RESULTS During the post-aSAH follow-up (median: 8.93 months/patient), 85 of 948 individuals (9%) in the final analysis developed symptomatic epilepsy (median: 3.43 months). In the majority of cases, epilepsy was diagnosed >3 weeks after aSAH (n = 67, 78.8%) and in survivors with poor outcome at discharge (mRS = 4-5, 15.8% vs. 5.3%, p < 0.0001). Of over 150 analyzed potential risk factors, the following parameters were independently associated with the risk of symptomatic epilepsy after aSAH: thyroid dysfunction (aHR = 1.81, p = 0.029), need for decompressive craniectomy (aHR = 2.32, p = 0.011) and shunt placement (aHR = 1.94, p = 0.022), prolonged tachycardia (≥4 days, aHR = 2.06, p = 0.025), as well as anemia signs (mean red blood cell count <3.6 × 1012 /L [aHR = 2.4, p = 0.015] and mean hematocrit <31% [aHR = 2.13, p = 0.044]) during first 2 weeks after aSAH. CONCLUSION Symptomatic epilepsy occurs predominantly in individuals with poor outcome at discharge and after the acute phase of aSAH. Knowledge of risk factors associated with aSAH-related epilepsy might help in early identification and treatment of compromised individuals, and therefore, help to improve their outcome.
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13
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Rheims S, Sperling MR, Ryvlin P. Drug-resistant epilepsy and mortality-Why and when do neuromodulation and epilepsy surgery reduce overall mortality. Epilepsia 2022; 63:3020-3036. [PMID: 36114753 PMCID: PMC10092062 DOI: 10.1111/epi.17413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
Patients with drug-resistant epilepsy have an increased mortality rate, with the majority of deaths being epilepsy related and 40% due to sudden unexpected death in epilepsy (SUDEP). The impact of epilepsy surgery on mortality has been investigated since the 1970s, with increased interest in this field during the past 15 years. We systematically reviewed studies investigating mortality rate in patients undergoing epilepsy surgery or neuromodulation therapies. The quality of available evidence proved heterogenous and often limited by significant methodological issues. Perioperative mortality following epilepsy surgery was found to be <1%. Meta-analysis of studies that directly compared patients who underwent surgery to those not operated following presurgical evaluation showed that the former have a two-fold lower risk of death and a three-fold lower risk of SUDEP compared to the latter (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.29-0.56; p < .0001 for overall mortality and OR 0.32, 95% CI: 0.18-0.57; p < .001 for SUDEP). Limited data are available regarding the risk of death and SUDEP in patients undergoing neuromodulation therapies, although some evidence indicates that vagus nerve stimulation might be associated with a lower risk of SUDEP. Several key questions remain to be addressed in future studies, considering the need to better inform patients about the long-term benefit-risk ratio of epilepsy surgery. Dedicated long-term prospective studies will thus be required to provide more personalized information on the impact of surgery and/or neuromodulation on the risk of death and SUDEP.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Mickael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaudois University Hospital Center, Lausanne, Switzerland
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14
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Development of an epileptic seizure prediction algorithm using R–R intervals with self-attentive autoencoder. ARTIFICIAL LIFE AND ROBOTICS 2022. [DOI: 10.1007/s10015-022-00832-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractEpilepsy is a neurological disorder that may affect the autonomic nervous system (ANS) from 15 to 20 min before seizure onset, and disturbances of ANS affect R–R intervals (RRI) on an electrocardiogram (ECG). This study aims to develop a machine learning algorithm for predicting focal epileptic seizures by monitoring R–R interval (RRI) data in real time. The developed algorithm adopts a self-attentive autoencoder (SA-AE), which is a neural network for time-series data.
The results of applying the developed seizure prediction algorithm to clinical data demonstrated that it functioned well in most patients; however, false positives (FPs) occurred in specific participants. In a future work, we will investigate the causes of FPs and optimize the developing seizure prediction algorithm to further improve performance using newly added clinical data.
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15
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Carmona-Puerta R, Lorenzo-Martínez E. Nonspecific ventricular repolarization abnormalities: A wolf in sheep's clothing. Rev Clin Esp 2022; 222:S2254-8874(22)00054-6. [PMID: 35842412 DOI: 10.1016/j.rceng.2022.03.008] [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: 02/21/2022] [Accepted: 03/16/2022] [Indexed: 10/17/2022]
Abstract
The term nonspecific ventricular repolarization abnormalities refers to a set of minor alterations of the ST segment and/or the T wave. For a long time, they have been of little clinical interest as they do not translate into specific diagnoses. It has even been asserted that they constitute benign electrocardiographic findings. Their presence has been reported in various cardiovascular and non-cardiovascular diseases. However, it is frequently identified in apparently healthy asymptomatic people. A growing number of studies demonstrate their importance as predictors of cardiovascular morbidity and mortality, expanding their spectrum towards cardiovascular prevention. In light of the body of scientific evidence, it is imperative that the traditional view of nonspecific ventricular repolarization abnormalities changes.
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Affiliation(s)
- R Carmona-Puerta
- Servicio de Electrofisiología y Arritmología, Hospital Universitario Cardiocentro Ernesto Guevara, Santa Clara, Cuba.
| | - E Lorenzo-Martínez
- Departamento de Fisiología, Universidad de Ciencias Médicas de Villa Clara, Santa Clara, Cuba
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16
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Carmona-Puerta R, Lorenzo-Martínez E. Trastornos inespecíficos de la repolarización ventricular: un lobo con piel de oveja. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Simultaneous Determination of Lamotrigine, Oxcarbazepine, Lacosamide, and Topiramate in Rat Plasma by Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry. Int J Anal Chem 2022; 2022:1838645. [PMID: 35321047 PMCID: PMC8938153 DOI: 10.1155/2022/1838645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/24/2022] [Indexed: 12/21/2022] Open
Abstract
This study established an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method to study the pharmacokinetics of four antiepileptic drugs, lamotrigine, oxcarbazepine, lacosamide, and topiramate, in rats after oral administration. The gradient elution was performed on a UPLC HSS T3 (2.1 mm × 100 mm, 1.8 μm) column with acetonitrile-0.1% formic acid as the mobile phase at a flow rate of 0.4 mL/min. Protein precipitation by acetonitrile was adopted for plasma sample pretreatment. Electrospray- (ESI-) positive/negative ion switching and multiple reaction monitoring (MRM) modes were adopted for ion quantitative determination of antiepileptic drugs. UPLC-MS/MS detection and Drug and Statistics (DAS) software fitting were performed to blood samples collected from rats after oral administration of lamotrigine, oxcarbazepine, lacosamide, and topiramate (5 mg/kg). All drugs examined showed linearity within 5–5000 ng/ml (R2 > 0.9987), the intraday accuracy was within 92%–108%, and the interday accuracy was within 93%–109%. The relative standard deviations (RSD) of intraday and interday were less than 15%. The matrix effect was within 91%–105%, and the recovery was better than 88%. The established UPLC-MS/MS method was successfully applied to the pharmacokinetic study of lamotrigine, oxcarbazepine, lacosamide, and topiramate in rats.
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18
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Rheims S. Autonomic dysfunction in developmental and epileptic encephalopathies: a daily-life issue. Dev Med Child Neurol 2021; 63:1367. [PMID: 34379809 DOI: 10.1111/dmcn.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
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19
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COVID-19 prevalence and mortality in people with epilepsy: A nation-wide multicenter study. Epilepsy Behav 2021; 125:108379. [PMID: 34731719 PMCID: PMC9759834 DOI: 10.1016/j.yebeh.2021.108379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/01/2021] [Accepted: 10/02/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND To assess the prevalence, severity, and mortality of COVID-19 in people with epilepsy (PWE) and evaluate seizure control in PWE during and after COVID-19. METHODS Retrospective, observational, multicenter study conducted in 14 hospitals. Medical records of randomly selected PWE followed at neurology outpatient clinics were reviewed. Proportion of PWE with a positive test for SARS-CoV-2 during 2020 was calculated. Risk factors associated with COVID-19 and its morbimortality were evaluated. RESULTS 2751 PWE were included, mean age 48.8 years (18-99), 72.4% had focal epilepsy, and 35% were drug-refractory. COVID-19 prevalence in PWE was 5.53%, while in the Spanish population was 4.26%. Proportion of admissions to hospital, ICU, and deaths in PWE were 17.1%, 2%, and 4.61% of COVID-19 cases, while in Spanish population were 10.81%, 0.95%, and 2.57%, respectively. A severe form of COVID-19 occurred in 11.8%; dyslipidemia, institutionalization at long-term care facilities, intellectual disability, and older age were associated risk factors. Older age, hypertension, dyslipidemia, cardiac disease, and institutionalization were associated with mortality from COVID-19. Seizure control was stable in 90.1% of PWE during acute COVID-19, while 8.6% reported an increase in seizure frequency. During post-COVID-19 follow-up, 4.6% reported seizure control worsening. CONCLUSIONS COVID-19 was moderately prevalent in PWE. One out of 5 patients required medical attention and 4.6% died due to COVID-19. Older age, dyslipidemia, institutionalization, and intellectual disability were significant risk factors associated with severe COVID-19. Seizure control remained stable during COVID-19 and throughout long-term follow-up in most PWE who contracted the infection.
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Trigger, risk factor, and self-organizing criticality - One more piece of the puzzle to explain increased mortality in epilepsy? Epilepsy Behav 2021; 122:108123. [PMID: 34144457 DOI: 10.1016/j.yebeh.2021.108123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
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21
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Hagiwara K, Okadome T, Mukaino T, Uehara T, Tanaka H, Kamada T, Miyoshi A, Akamatsu N, Ohara S, Shigeto H. Ictal asystole as a manifestation of pure insular epilepsy. Seizure 2021; 91:192-195. [PMID: 34218043 DOI: 10.1016/j.seizure.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Koichi Hagiwara
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan.
| | - Toshiki Okadome
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiko Mukaino
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taira Uehara
- Epilepsy Center, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Hideaki Tanaka
- Department of Neurosurgery, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Takashi Kamada
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Ayako Miyoshi
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Naoki Akamatsu
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan; Epilepsy Center, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Shinji Ohara
- Department of Neurosurgery, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Hiroshi Shigeto
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan; Division of Medical Technology, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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