Changes in the heartbeat-evoked potential are associated with functional seizures.
Changes in the heartbeat-evoked potential are associated with functional seizures.
复制标题
心跳诱发电位的变化与功能性癫痫发作有关。
DOI：
10.1136/jnnp-2022-330167
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Elkommos S
中科院分区：
文献类型：
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作者：
Elkommos S
背景：功能性癫痫（FS）患者在癫痫发作前可经历精神分离（人格解体）。人格解体反映了分离，这可能与内感受加工的变化有关。心电诱发电位（HEP）是一种脑电图（EEG）标记内感受加工。目的评估HEP诱发的内感受性加工改变是否发生在FS之前，并将其与癫痫发作（ES）进行比较。方法对25例FS患者和19例ES患者进行视频脑电图监测，计算脑电图的shep幅值，并比较其间期和痫前状态。HEP振幅差计算为预测HEP振幅减去间隔HEP振幅。采用受试者工作特征（ROC）曲线分析，评价HEP振幅差在区分FS和ES中的诊断价值。结果FS组在F8（效应值rB=0.612，错误发现率（FDR）校正q=0.030）和C4 （rB=0.600， FDR校正q=0.035）时，间期和孕前状态之间HEP振幅显著降低。ES组各状态间HEP振幅无差异。诊断组间，FS组与ES组HEP振幅差异在F8 （rB=0.423， fdr校正q=0.085）和C4 （rB=0.457， fdr校正q=0.085）。利用额电极和中央电极的HEP振幅差加上性别，我们发现ROC曲线下面积为0.893，灵敏度=0.840，特异性=0.842。结论我们的数据支持异常内感受发生在FS之前的观点。HEP振幅的变化可能反映FS的神经生理生物标志物，可能在FS和ES的鉴别诊断中具有实用价值。
BackgroundPatients with functional seizures (FS) can experience dissociation (depersonalisation) before their seizures. Depersonalisation reflects disembodiment, which may be related to changes in interoceptive processing. The heartbeat-evoked potential (HEP) is an electroencephalogram (EEG) marker of interoceptive processing.AimTo assess whether alterations in interoceptive processing indexed by HEP occur prior to FS and compare this with epileptic seizures (ES).MethodsHEP amplitudes were calculated from EEG during video-EEG monitoring in 25 patients with FS and 19 patients with ES, and were compared between interictal and preictal states. HEP amplitude difference was calculated as preictal HEP amplitude minus interictal HEP amplitude. A receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of HEP amplitude difference in discriminating FS from ES.ResultsThe FS group demonstrated a significant reduction in HEP amplitude between interictal and preictal states at F8 (effect size rB=0.612, false discovery rate (FDR)-corrected q=0.030) and C4 (rB=0.600, FDR-corrected q=0.035). No differences in HEP amplitude were found between states in the ES group. Between diagnostic groups, HEP amplitude difference differed between the FS and ES groups at F8 (rB=0.423, FDR-corrected q=0.085) and C4 (rB=0.457, FDR-corrected q=0.085). Using HEP amplitude difference at frontal and central electrodes plus sex, we found that the ROC curve demonstrated an area under the curve of 0.893, with sensitivity=0.840 and specificity=0.842.ConclusionOur data support the notion that aberrant interoception occurs prior to FS. Changes in HEP amplitude may reflect a neurophysiological biomarker of FS and may have diagnostic utility in differentiating FS and ES.