Alteration of cardiac function in patients with temporal lobe epilepsy: Different roles of EEG-ECG monitoring and spectral analysis of RR variability

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Massetani R, Strata G, Galli R, Gori S, Gneri C, Limbruno U, Di Santo D, Mariani M, and Murri L (1997) Alteration of cardiac function in patients with temporal lobe epilepsy: Different roles of EEG-ECG monitoring and spectral analysis of RR variability. Epilepsia 38:3 363–9.

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Abstract: PURPOSE: Because several reports have described the relation between epilepsy and cardiac arrhythmias and suggest that changes in autonomic neural control of the heart could be involved in the pathogenesis of sudden unexplained death in patients with epilepsy, the aim of this study was to evaluate cardiac function in patients with temporal lobe epilepsy. METHODS: Sixty-five patients with epilepsy were evaluated by simultaneous ambulatory 24-h EEG-ECG monitoring, and in 30 of these, power spectral analysis of relative-risk (RR) variability also was carried out, both in the supine position and in a passive tilt position at 60 degrees. The power spectrum of RR variability, the two major spectral components detectable at low frequency (LF) and at high frequency (HF), respectively, and the LF/HF ratio were calculated. RESULTS: By EEG-ECG monitoring, we recorded six partial seizures, and in four cases, discharges were associated with sinus tachycardia. However, interictally the occurrence of ventricular and supraventricular arrhythmias was not different from that in normal subjects. The spectral analysis of RR variability, on the other hand, demonstrated in patients with epilepsy a significant decrease in the total RR variability and in both of its components (LF and HF) in the supine position, and of the LF/HF ratio in orthostatic position. CONCLUSIONS: These findings suggest that the spectral analysis of RR variability may detect disorders of autonomic cardiac control in patients with epilepsy, even in the absence of abnormal findings during ECG monitoring. This alteration, which is more severe in cases with right EEG focus, could play a role in the pathogenesis of cardiac arrhythmias.

Keywords: Temporal lobe epilepsy, Sudden unexplained death in patients with epilepsy, ECG monitoring, Heart rate variability, Autonomic disorders

Context

  • 65 adult patients with temporal lobe epilepsy participated in 24 hour ambulatory EEG monitoring, and in 30 of these patients RR variability was also measured in a clinical laboratory using a tilt table. Between seizures, arrhythmia frequency was similar to that seen in controls, but RR variability was lower in epilepsy patients. High-frequency and low-frequency variability changes depended on the position of the patient on the tilt table. Interstingly, in the supine measurements both LF and HF components of RR variability were lower than controls, while in orthostasis the power in the LF range was much lower in patients than in controls, indicating impaired sympathetic reaction, while HF power, a surrogate for vagal tone, was low in both controls and patients. Patients with right hemisphere TLE had much lower LF power when supine than other epilepsy patients, possibly indicating a role for this region in providing basal sympathetic tone.

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