Clinical Research Of Risk Factors For Ictal Heart Rate Changes In Focal Epilepsy

Objective:We analyzed risk factors for ictal heart rate changes in focal epilepsy via video-EEG-ECG(VEEG) monitoring, and we sought to gain some insight into the mechanisms involved in the neuronal regulation of cardiovascular function,in order to early onset of seizure control, to reduce cardiac damage in epileptic seizures.Methods: We retrospectively analyzed VEEG data on 183 clinical seizures from 54 focal epileptic patients referred to First Hospital Affiliated to Soochow University for presurgical evaluation between January 2013 and December 2015,including simple partial seizure(SPS)25, complex partial seizure( CPS)44 and partial seizures with secondary generalized tonic-clonic seizure(sGTCS)114,except primary total seizures.Most of these patients were admitted to our unit to determine their suitability for epilepsy surgery. We measured the heart rate for the 5 minutes that preceded the seizure onset at rest state as the baseline heart rate in focal epileptic patients via VEEG.The maximum heart rate during seizures were identified(instantaneous,calculation of the shortest RR interval).Seizure onset was defined as EEG seizure onset. Every heart rate change is the difference between the maximum heart rate and the baseline heart rate.The impact of gender,age,consciousness state,localization and lateralization of the epileptogenic focus,seizure type,duration of epilepsy, partial seizures with secondary generalized tonic-clonic seizure frequency(sGTCS frequency),number of anti-epileptic drugs(number of AEDs) and etiology for ictal heart rate changes in focal epilepsy were evaluated.Results:1. In this analysis,the ictal heart rate changes were related to age, consciousness state, seizure type, duration of epilepsy, sGTCS frequency in focal epilepsy. However,gender, localization and lateralization of the epileptogenic focus, number of AEDs and etiology showed no significant effect on ictal heart rate changes in focal epilepsy.2. By Spearman correlation analysis,we found ictal heart rate changes were correlated with age, in other words, as the age increased, the change of heart rate of epileptic seizures increased more obviously.3. By simple linear regression analysis, we observed that ictal heart rate changes were correlated with age,consciousness state, seizure type, sGTCS frequency. By multiple linear regression analysis, we observed that ictal heart rate changes were independently correlated with age, seizure type and sGTCS frequency.The older, partial seizures with secondary generalized tonic-clonic seizure, sGTCS frequency of more than 4 times per month are risk factors for heart damage of seizures.Conclusion:1. Adults, sleep,sGTCS, 5-10 years of epilepsy duration and sGTCS frequency of more than 4 times per month led to higher ictal heart rate changes in focal epilepsy.2. By Spearman correlation analysis,we found ictal heart rate changes were positively correlated with age, in other words, as the age increased, the change of heart rate of epileptic seizures increased more obviously.3. Ictal heart rate changes were independently correlated with adults, s GTCS and sGTCS frequency of more than 4 times per month.The older, partial seizures with secondary generalized tonic-clonic seizure, sGTCS frequency of more than 4 times per month are risk factors for heart damage of seizures.In conclusion, to reduce cardiac damage in epileptic seizures,some measures can be conducted including early onset of seizure control, avoiding partial seizures with secondary generalized tonic-clonic seizure.