scholarly journals Interictal autonomic dysfunction in patients with epilepsy

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Kanar K. Shaker ◽  
Akram M. Al Mahdawi ◽  
Farqad B. Hamdan
Keyword(s):  
Temporal Lobe ◽  
Autonomic Function ◽  
Mental Arithmetic ◽  
Valsalva Maneuver ◽  
Sympathetic Skin Response ◽  
Deep Breathing ◽  
Unexpected Death ◽  
Hand Grip ◽  
Skin Response ◽  
Generalized Epilepsy

Abstract Background Autonomic nervous system (ANS) symptoms are frequently present in people with epilepsy (PwE). They are generally more prominent when they originate from the temporal lobe. We aim to investigate the alterations of autonomic functions during the interictal period in patient with temporal lobe epilepsy (TLE) and idiopathic generalized epilepsy (IGE) using heart-based tests, blood pressure (BP)-based tests and sympathetic skin response (SSR). Forty-eight PwE with disease duration ranging from 2 to 15 years and 51 healthy individuals were studied. Long-term electroencephalography (EEG) monitoring, the heart rate variability (HRV) during normal breathing, deep breathing, Valsalva maneuver and standing, BP responses during standing, to isometric hand grip and to mental arithmetic, and the SSR was recorded for all participants. Results 31 patients with TLE and 17 with IGE showed lower RR-IV values during deep breathing, Valsalva maneuver and standing, but not during rest, impaired BP responses during standing, isometric hand grip, and mental arithmetic. Also, prolonged SSR latencies. Within PwE group, no difference was noticed between males and females, nor between the left and right temporal lobes. Conclusion Abnormal autonomic (sympathetic and parasympathetic) regulatory functions suggest that epilepsy may alter the autonomic function and this is not only in TLE but rather in IGE too. These autonomic changes are irrespective of the localization of epilepsy between the two hemispheres. The ANS changes in epileptic patients, particularly those with autonomic symptoms, confirm that electrophysiologic measures of autonomic function may be of value in preventing sudden unexpected death in epilepsy.

scholarly journals Investigation of autonomic dysfunction in primary Raynaud’s phenomenon with sympathetic skin response (SSR), R-R interval variation (RRIV) and composite autonomic symptom score (COMPASS)-31

2021 ◽  
Vol 26 (4) ◽  
pp. 693-698
Author(s):  
Hüseyin Sicim ◽  
Özgür Boyraz ◽  
Ertan Demirdas ◽  
Hakan Kartal ◽  
Gökhan Erol ◽  
...  
Keyword(s):  
Autonomic Dysfunction ◽  
Valsalva Maneuver ◽  
Raynaud’S Phenomenon ◽  
Sympathetic Skin Response ◽  
Raynaud's Phenomenon ◽  
Deep Breathing ◽  
Control Groups ◽  
Significant Difference ◽  
Skin Response ◽  
And Control

Background: In this study, we aimed to investigate the autonomic dysfunction in patients with primary Raynaud’s phenomenon with using sympathetic skin response (SSR) as a neurophysiologic test, R-R interval variation analysis and composite autonomic symptom score (COMPASS)-31 questionnaire. Methods: Palmar SSR to median nerve electrical stimulation was recorded in 38 patients with 36 healthy age and sex-matched control subjects. The SSR was recorded from the palmar surface of both left and right hands for patients and control groups. The amplitudes and latencies formed as a result of electrical stimulation were calculated and compared between the two groups. Additionally, R-R interval variability was examined during normal breathing, deep breathing, standing up and Valsalva maneuver in both groups. Furthermore, we asked to complete the COMPASS-31 questionnaire, a validated tool to assess symptoms of autonomic dysfunction. And by calculating total COMPASS-31 scores, the relationship between the two groups was investigated. Results: The Raynaud’s phenomenon and control groups were similar in age (37.4 ± 11.6 vs. 34.9 ± 13.0 years), had identical gender ratios and similar body mass index (24.5 ± 6.1 vs. 25.7 ± 4.6%). Palmar SSR to median nerve stimulation of RP patients shows significantly delayed latency (1890 ± 146) (p=0.03). And no difference between amplitudes in comparison to the control group. In the patient and control groups, R-R interval measurements were evaluated during rest and deep breathing, standing up and Valsalva maneuver. When the R-R interval measurements of the patient and control groups at rest and deep breathing were compared, there was no statistically significant difference between the groups. In addition, COMPASS-31 questionnaire scoring system was applied to both groups. The mean COMPASS-31 score was higher in patient group (22.8 ± 13.8), than from healthy controls (8.9 ± 7.8) (p=0.02) Conclusions: Autonomic dysfunction plays a role in the etiology of Raynaud’s phenomenon, due to latency prolongation in the sympathetic skin response and significant difference between COMPASS-31 tests, and these tests can be used in the diagnosis stage of this disease.

Heart Rate/Stroke Volume Relationship During Upright Exercise in Long-Term Diabetics

1993 ◽  
Vol 18 (2) ◽  
pp. 148-162
Author(s):  
R. G. Haennel ◽  
K. K. Teo ◽  
A. Suthijumroon ◽  
M. P. J. Senaratne ◽  
M. Hetherington ◽  
...  
Keyword(s):  
Heart Rate ◽  
Stroke Volume ◽  
Cardiac Function ◽  
Autonomic Function ◽  
Valsalva Maneuver ◽  
Peak Exercise ◽  
Initial Increase ◽  
Key Words Diabetes Mellitus ◽  
Key Words Diabetes ◽  
Deep Breathing

The changes in stroke volume (SV) during upright exercise were studied in 20 insulin-dependent diabetics (IDDM) and 20 age- and sex-matched controls. None of the diabetics had any cardiovascular symptoms. In addition, tests of autonomic function were conducted in the diabetics, assessing changes in heart rate (HR) during deep breathing and the Valsalva maneuver. During exercise the SV in the controls gradually increased and then remained essentially unchanged until maximum HR was achieved. Seven of the diabetics failed to sustain an initial increase in SV (fall > 15%), eight showed a "delayed" increase in SV, and the remaining five demonstrated an increasing SV over the range from rest to peak exercise. Abnormal autonomic function results were found during deep breathing (four diabetics) and the Valsalva maneuver (four diabetics). Findings indicate that cardiac function could be abnormal in IDDM without evidence of autonomic dysfunction. This abnormality could be due to a specific cardiomyopathy. Key words: diabetes mellitus, cardiac function, upright exercise, autonomic neuropathy, cardiomyopathy

scholarly journals Cerebral Hemispheric Lateralization Associated with Hippocampal Sclerosis May Affect Interictal Cardiovascular Autonomic Functions in Temporal Lobe Epilepsy

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Rokia Ghchime ◽  
Halima Benjelloun ◽  
Hajar Kiai ◽  
Halima Belaidi ◽  
Fatiha Lahjouji ◽  
...  
Keyword(s):  
Heart Rate ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Cerebral Hemisphere ◽  
Autonomic Function ◽  
Hippocampal Sclerosis ◽  
Hemispheric Lateralization ◽  
Unexpected Death ◽  
Complex Partial Seizures ◽  
The Right

It is well established that the temporal lobe epilepsy (TLE) is linked to the autonomic nervous system dysfunctions. Seizures alter the function of different systems such as the respiratory, cardiovascular, gastrointestinal, and urogenital systems. The aim of this work was to evaluate the possible factors which may be involved in interictal cardiovascular autonomic function in temporal lobe epilepsy with complex partial seizures, and with particular attention to hippocampal sclerosis. The study was conducted in 30 patients with intractable temporal lobe epilepsy (19 with left hippocampal sclerosis, 11 with right hippocampal sclerosis). All subjects underwent four tests of cardiac autonomic function: heart rate changes in response to deep breathing, heart rate, and blood pressure variations throughout resting activity and during hand grip, mental stress, and orthostatic tests. Our results show that the right cerebral hemisphere predominantly modulates sympathetic activity, while the left cerebral hemisphere mainly modulates parasympathetic activity, which mediated tachycardia and excessive bradycardia counterregulation, both of which might be involved as a mechanism of sudden unexpected death in epilepsy patients (SUDEP).

scholarly journals Ictal Cardiac Ryhthym Abnormalities

2016 ◽  
Vol 10 (1) ◽  
pp. 105-109 ◽  
Author(s):  
Rushna Ali
Keyword(s):  
Risk Factor ◽  
Autonomic Function ◽  
Seizure Control ◽  
Preventive Strategy ◽  
Cardiac Autonomic Function ◽  
Seizure Onset ◽  
Unexpected Death ◽  
Prolonged Duration ◽  
Clonic Seizures ◽  
Generalized Epilepsy

Cardiac rhythm abnormalities in the context of epilepsy are a well-known phenomenon. However, they are under-recognized and often missed. The pathophysiology of these events is unclear. Bradycardia and asystole are preceded by seizure onset suggesting ictal propagation into the cortex impacting cardiac autonomic function, and the insula and amygdala being possible culprits. Sudden unexpected death in epilepsy (SUDEP) refers to the unanticipated death of a patient with epilepsy not related to status epilepticus, trauma, drowning, or suicide. Frequent refractory generalized tonic-clonic seizures, anti-epileptic polytherapy, and prolonged duration of epilepsy are some of the commonly identified risk factors for SUDEP. However, the most consistent risk factor out of these is an increased frequency of generalized tonic–clonic seizures (GTC). Prevention of SUDEP is extremely important in patients with chronic, generalized epilepsy. Since increased frequency of GTCS is the most consistently reported risk factor for SUDEP, effective seizure control is the most important preventive strategy.

Abstract 19396: Impaired Autonomic Modulation During the Valsalva Maneuver Predicts Ischemia in Patients With Coronary Artery Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Amit J Shah ◽  
Ayman Alkhoder ◽  
Malik Obideen ◽  
Ronnie Ramadan ◽  
Kobina Wilmot ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Autonomic Function ◽  
Valsalva Maneuver ◽  
Standing Position ◽  
Deep Breathing ◽  
Cardiac Events ◽  
Pharmacological Stress ◽  
Increased Risk ◽  
Autonomic Reflexes ◽  
Artery Disease

Introduction: Previous studies have found that lower resting short-term heart rate variability (HRV), a measure of autonomic dysfunction, predicts adverse cardiac events. Abnormal autonomic function may precipitate myocardial ischemia. Physiologic challenges like Valsalva and deep breathing may also provide important data by modulating preload/afterload and stimulating various autonomic receptors. Methods: We examined autonomic function in 166 patients with CAD using the ANSAR method (ANX 3.0, ANSAR Inc. Philadelphia, PA). HRV was measured in the sitting position, standing position, during deep breathing, and during Valsalva. After ANSAR testing, patients underwent 99m Tc[[Unable to Display Character: ‐]]sestamibi myocardial perfusion imaging at rest and with exercise or pharmacological stress. A summed difference score (SDS) was computed to quantify ischemia using a 17-segment model with observer-independent software. Multivariable models adjusted for CAD risk factors, psychiatric comorbidities, and medications. Results: The mean (SD) age was 62 (9) years, 75% were men, and 31% had ischemia (SDS ≥ 4). Both low (LF) and high (HF) frequency HRV during all 4 conditions were associated with ischemia in unadjusted models (table), but after multivariable adjustment, only LF and HF HRV during Valsalva and deep breathing were still associated with ischemia. The strongest association was found with LF HRV during Valsalva, such that every 10% decrease in LF HRV during Valsalva (p=0.003, adjusted) associated with a 1 point increase in SDS. When dividing patients into 4 categories of SDS score (0, 1-3, 4-7, ≥ 8), the SDS ≥ 8 category had a lower LF HRV during Valsalva than all other categories, most notably compared to SDS=0 (78% reduction in LF HRV). Conclusion: Low HF and LF HRV are associated with increased risk of myocardial ischemia in CAD patients. Most notably, autonomic inflexibility during Valsalva may help uncover underlying vulnerabilities in autonomic reflexes that predict ischemia burden.

Utility of Autonomic Function Tests to Differentiate Dementia with Lewy Bodies and Parkinson Disease with Dementia from Alzheimer Disease

2017 ◽  
Vol 79 (1-2) ◽  
pp. 27-32 ◽  
Author(s):  
Shuta Toru ◽  
Tadashi Kanouchi ◽  
Takanori Yokota ◽  
Yosuke Yagi ◽  
Akira Machida ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Parkinson Disease ◽  
Dementia With Lewy Bodies ◽  
Autonomic Function ◽  
Lewy Bodies ◽  
Sympathetic Skin Response ◽  
Tilt Test ◽  
Autonomic Function Tests ◽  
Function Tests ◽  
Skin Response

Objective: We studied autonomic disturbance in patients with dementia with Lewy bodies (DLB), Parkinson disease with dementia (PDD), Alzheimer disease (AD), to determine whether autonomic function tests can be used to distinguish these disorders. Methods: Autonomic function was tested in 56 patients with DLB, 37 patients with PDD, and 59 patients with AD by using the sympathetic skin response, coefficient of variation in R-R interval, the head-up tilt test, serum norepinephrine concentration, and 123I-meta-iodobenzylguanidine cardiac scintigraphy. Symptoms of autonomic dysfunction, such as constipation, urinary symptoms, and orthostatic hypotension, were also noted. Results: The groups did not differ on baseline characteristics other than those associated with Parkinsonism and dementia. All patients with DLB and PDD had some dysautonomia, whereas rates were much lower for patients with AD (19%). Significantly more DLB and PDD patients than AD patients showed abnormalities on autonomic function tests. Conclusions: Autonomic function tests might be quite useful to distinguish DLB and PDD from AD.

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