Postictal generalized EEG suppression is not associated with periictal cardiac autonomic instability in people with convulsive seizures.
Postictal generalized EEG suppression is not associated with periictal cardiac autonomic instability in people with convulsive seizures.
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作者：
Lamberts RJ;Laranjo S;Kalitzin SN;Velis DN;Rocha I;Sander JW;Thijs RD
发作后全身性脑电图抑制（PGES）似乎是癫痫猝死（SUDEP）的一个病理生理学标志。最近有人提出，PGES的存在和持续时间可能是SUDEP风险的预测因子。关于PGES的病因学知之甚少。我们对50例记录在数字视频EEG上的惊厥性发作（CS）患者进行了回顾性病例对照研究。由两名独立观察员审查每个人的一个CS是否存在PGES和持续时间：分析发作前和发作后心率（HR）（发作前1分钟和发作结束后1、3、5、15和30分钟）和心率变异性（HRV）的频域测量值，包括低频与高频功率的比值。评估PGES与发作期自主神经变化之间的关系，以及其与几个临床变量的相关性。37例（74%）患者表现出PGES，13例（26%）未表现出PGES。CS导致发作期HR和LF/HF比值显著增加。PGES与发作期HR（PGES+和PGES−发作之间的平均HR差异：−2 bpm，95% CI −10至+6 bpm）和HRV变化均不相关。PGES持续时间与发作期HR变化之间无相关性。PGES患者在癫痫发作前更可能处于睡眠状态（OR 4.7，95% CI 1.2-18.3），并且癫痫发作的年龄更高（中位年龄15岁vs 4岁）。PGES与心脏自主神经不稳定性指标的实质性变化无关，但在睡眠引起的CS中更为普遍。
Postictal generalized EEG suppression (PGES) seems to be a pathophysiological hallmark in ictal recordings of sudden unexpected death in epilepsy (SUDEP). It has recently been suggested that presence and duration of PGES might be predictors of SUDEP risk. Little is known about the aetiology of PGES. We conducted a retrospective case-control study in 50 people with convulsive seizures (CS) recorded on digital video-EEG. One CS per individual was reviewed for presence and duration of PGES by two independent observers: Pre- and postictal heart rate (HR) (1 minute before seizure onset and 1, 3, 5, 15 and 30 minutes after seizure end) and frequency domain measures of heart rate variability (HRV) including the ratio of low versus high frequency power were analyzed. The relationship between PGES and peri-ictal autonomic changes was evaluated, as well as its association with several clinical variables. Thirty seven (74%) individuals exhibited PGES and 13 (26%) did not. CS resulted in a significant increase of peri-ictal HR and the LF/HF ratio. PGES was associated with neither peri-ictal HR (mean HR difference between PGES+ and PGES− seizures: −2 bpm, 95% CI −10 to +6 bpm) nor HRV change. There was no association between the duration of PGES and peri-ictal HR change. People with PGES were more likely to be asleep prior to seizure onset (OR 4.7, 95% CI 1.2-18.3) and had a higher age of onset of epilepsy (median age 15 vs. 4 years). PGES was not associated with substantial changes in measures of cardiac autonomic instability but was more prevalent in CS arising from sleep.
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