Document Detail

Autonomic changes with seizures correlate with postictal EEG suppression.
MedLine Citation:
PMID:  22539579     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) poses a poorly understood but considerable risk to people with uncontrolled epilepsy. There is controversy regarding the significance of postictal generalized EEG suppression as a biomarker for SUDEP risk, and it remains unknown whether postictal EEG suppression has a neurologic correlate. Here, we examined the profile of autonomic alterations accompanying seizures with a wrist-worn biosensor and explored the relationship between autonomic dysregulation and postictal EEG suppression.
METHODS: We used custom-built wrist-worn sensors to continuously record the sympathetically mediated electrodermal activity (EDA) of patients with refractory epilepsy admitted to the long-term video-EEG monitoring unit. Parasympathetic-modulated high-frequency (HF) power of heart rate variability was measured from concurrent EKG recordings.
RESULTS: A total of 34 seizures comprising 22 complex partial and 12 tonic-clonic seizures from 11 patients were analyzed. The postictal period was characterized by a surge in EDA and heightened heart rate coinciding with persistent suppression of HF power. An increase in the EDA response amplitude correlated with an increase in the duration of EEG suppression (r = 0.81, p = 0.003). Decreased HF power correlated with an increase in the duration of EEG suppression (r = -0.87, p = 0.002).
CONCLUSION: The magnitude of both sympathetic activation and parasympathetic suppression increases with duration of EEG suppression after tonic-clonic seizures. These results provide autonomic correlates of postictal EEG suppression and highlight a critical window of postictal autonomic dysregulation that may be relevant in the pathogenesis of SUDEP.
M-Z Poh; T Loddenkemper; C Reinsberger; N C Swenson; S Goyal; J R Madsen; R W Picard
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-04-25
Journal Detail:
Title:  Neurology     Volume:  78     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-05     Completed Date:  2012-08-09     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1868-76     Citation Subset:  AIM; IM    
Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA.
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MeSH Terms
Autonomic Nervous System / physiopathology*
Death, Sudden / etiology
Epilepsy / complications*,  physiopathology*
Galvanic Skin Response / physiology*
Heart Rate / physiology
Seizures / physiopathology
Single-Blind Method
Comment In:
Neurology. 2013 Apr 16;80(16):1538-9   [PMID:  23589642 ]

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