Profiles of instant heart rate during partial seizures

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Smith PE, Howell SJ, Owen L, and Blumhardt LD (1989) Profiles of instant heart rate during partial seizures. Electroencephalogr Clin Neurophysiol 72:3 207–17.

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Abstract: Instant heart rate (R-R intervals) can be readily studied during spontaneous seizures recorded with ambulatory cassette AEEG/AECG techniques. Ninety-three seizures were recorded in 32 patients with complex partial epilepsy. Instant R-R interval plots showed that 74% of seizures were associated with a dominant tachycardia, the most characteristic features of which were the initial steep acceleration phase at seizure onset and the wide fluctuations in heart rate ('exaggerated sinus arrhythmia') which occurred during and immediately after the seizure. Five percent of seizures were associated with a dominant but transient phase of heart rate slowing during or towards the end of the seizure. Nineteen percent of seizures showed equivocal or negative ictal effects on the heart rate and rhythm despite unequivocal AEEG seizure discharges. Conversely, other patients had characteristic heart rate changes despite equivocal AEEG abnormality. The heart rate profiles showed striking seizure-to-seizure similarities when multiple fits were recorded in the same patient. Ratemeter profiles may be clinically useful to locate epileptic seizures in long duration records; they can help to locate seizures which are either inaccurately timed or poorly identified by the event marker, or not clearly associated with definite AEEG changes. The secondary cardiac effects of epilepsy may be misdiagnosed if their primary cerebral origin is not suspected.

Keywords: Ambulatory monitoring; Seizures; Electrocardiogram; Heart rate

Context

  • Study of 32 patients with complex partial epilepsy using ambulatory EEG and EKG. Among 93 seizures, 74% were associated with tachycardia and large fluctuations in heart rate, and 5% showed bradycardia. Some seizures showed no effect on EKG, while some heart rate changes characteristic for individual patients during seizures could also be seen in those patients in the absence of seizures. Interestingly, heart rate fluctuations were highly consistent in each patient across seizures.

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