Heart rate dynamics in refractory and well controlled temporal lobe epilepsy

Objectives: Disorders of cardiovascular and other autonomic nervous system functions are often found in patients with temporal lobe epilepsy (TLE). Cardiovascular dysregulation in TLE has previously been quantified assessing traditional time and frequency domain measures of heart rate (HR) variabili...

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Published in:	Journal of neurology, neurosurgery and psychiatry Vol. 72; no. 1; pp. 26 - 30
Main Authors:	Ansakorpi, H, Korpelainen, J T, Huikuri, H V, Tolonen, U, Myllylä, V V, Isojärvi, J I T
Format:	Journal Article
Language:	English
Published:	London BMJ Publishing Group Ltd 01.01.2002 BMJ BMJ Publishing Group LTD BMJ Group
Subjects:	Adult AEDs Anticonvulsants - administration & dosage Anticonvulsants - adverse effects antiepileptic drugs ApEn approximate entropy autonomic dysfunction autonomic nervous system Autonomic Nervous System - drug effects Autonomic Nervous System - physiopathology Biological and medical sciences Blood pressure Cardiac dysrhythmias Cardiology. Vascular system Causes of Death, Sudden - etiology Electrocardiography, Ambulatory Epilepsy Epilepsy, Temporal Lobe - drug therapy Epilepsy, Temporal Lobe - physiopathology Female Fractals Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Heart Heart beat Heart rate Heart Rate - drug effects Heart Rate - physiology Humans Laboratories Male Measurement Medical imaging Medical sciences Mortality Nervous system Nervous system (semeiology, syndromes) Neurology Nonlinear Dynamics Physiological aspects Regulation Risk Factors Signal Processing, Computer-Assisted Studies Sudden death sudden unexpected death in epilepsy SUDEP temporal lobe epilepsy TLE Finland Human Temporal lobe Nervous system diseases Arrhythmia Treatment efficiency Complex partial epilepsy Cardiovascular disease Exploration Anticonvulsant Cerebral disorder Electrodiagnosis Symptomatology Chemotherapy Treatment Heart disease Central nervous system disease Diseases of the autonomic nervous system Electrocardiography Temporal lobe epilepsy Ambulatory Diagnosis Comparative study
ISSN:	0022-3050, 1468-330X
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Summary:	Objectives: Disorders of cardiovascular and other autonomic nervous system functions are often found in patients with temporal lobe epilepsy (TLE). Cardiovascular dysregulation in TLE has previously been quantified assessing traditional time and frequency domain measures of heart rate (HR) variability from short term ECG recordings. However, new complexity and fractal measures of HR variability based on non-linear dynamics and fractals (“chaos theory”) may disclose certain patterns of HR dynamics that cannot be detected using only conventional measures. Methods: In addition to the traditional spectral and non-spectral components of HR variability, fractal correlation properties, approximate entropy (ApEn) of RR interval dynamics, and the slope of the power law relation were measured from 24 hour ambulatory ECG recordings to evaluate interictal autonomic cardiovascular regulatory function in 19 patients with refractory TLE, 25 patients with well controlled TLE, and in 34 healthy age and sex matched control subjects. Results: The traditional time and frequency domain measures were lower in patients with TLE than in controls (p<0.05). In addition, the power law slope (p<0.005) and ApEn (p<0.05) were also reduced in TLE patients. Furthermore, ApEn was smaller in patients with refractory TLE than in patients with well-controlled TLE ( p<0.01), whereas the long term fractal correlation value α2 was lower in patients with well controlled TLE (p<0.05). An altered HR variation was not associated with any particular AED regimen. Conclusions: In addition to reduced overall HR variability, the long term fractal organisation and complexity of HR dynamics seem to be altered in TLE. These abnormalities in HR behaviour may partly contribute to the occurrence of adverse cardiovascular events, such as life threatening arrhythmias in patients with TLE.
Bibliography:	Correspondence to:  Dr H Ansakorpi, Department of Neurology, University of Oulu, Box 5000, Fin-90014, University of Oulu, Finland;  htansakorpi@hotmail.com local:0720026 PMID:11784820 ark:/67375/NVC-C12XMLR8-P href:jnnp-72-26.pdf istex:CCC69221B0BFA3E69B383E6D1604B5D2826BC7DF ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0022-3050 1468-330X
DOI:	10.1136/jnnp.72.1.26