Ictal tachycardia: Its discriminating potential between temporal and extratemporal seizure foci

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Garcia M, D’Giano C, Estellés S, Leiguarda R, and Rabinowicz A (2001) Ictal tachycardia: Its discriminating potential between temporal and extratemporal seizure foci. Seizure 10:6 415–9.

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Abstract: A wide variety of CNS lesions have been associated with changes in heart rate (HR). However, in epileptic patients their value to lateralize seizure onset remains controversial. This study aims to assess if HR changes associated with partial onset seizures could be useful in lateralizing seizure onset. We analysed HR changes on 100 seizures from 38 consecutive patients (mean age: 27.5 years) admitted for video-EEG telemetry monitoring. We evaluated the R-R interval 30 seconds before the seizure onset and 10, 20 and 120 seconds after the onset. We assessed whether there was a correlation between HR changes and seizure type, left/right differences and different semiological components for each seizure. We recorded 100 seizures. Three non-lateralized seizures were excluded from the analysis; 63/97 (65%) had left hemisphere onset, mainly from the temporal lobe (57.7%). The mean baseline HR was 77 beats per minute Ictal tachycardia (HR: > or = 107.06 beats per minute) was detected in 32 seizures, with ictal onset from the mesial temporal lobe structures in 23/32; 16/32 occurred during the first 10 seconds and 16/32 during the next 20 seconds from the seizure onset independently of the site of origin. Among the different semiological components for each seizure, only dystonic posturing and automatism correlated with HR increments. We did not find bradycardia in our series. Ictal tachycardia occurs most frequently with seizures arising from the mesial temporal lobe and it may not reliably predict the lateralization of seizure onset.

Keywords: heart rate; epilepsy; ictal onset


  • Assessed utility of change in heart rate at seizure onset for localization of seizure. Using 97 lateralized seizures from 38 patients admitted to a monitoring unit, evaluated R-R interval at multiple time points before and after seizure onset. All patients were treated with AED. Tachycardia was observed in 32 of 97 seizures, with mesial temporal lobe onset in 23 of the 32. Temporal lobe seizures were more likely to cause heart rate changes than were seizures with other foci. No clear lateralization was observed. Interestingly, no bradycardia was observed.


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