Spontaneous oscillations in cerebral blood flow velocities in middle cerebral arteries in control subjects and patients with epilepsy
Spontaneous oscillations in cerebral blood flow velocities in middle cerebral arteries in control subjects and patients with epilepsy
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DOI：
10.1161/01.str.28.12.2457
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发表时间：
1997-12-01
期刊：
影响因子：
8.3
通讯作者：
Ringelstein, EB
中科院分区：
文献类型：
--
作者：
Diehl, B;Diehl, RR;Ringelstein, EB
背景和目的交感神经系统介导的心律失常与癫痫患者的突然、不明原因的死亡有关。通过经颅多普勒测量的脑血流速度（CBFV）的特征在于缓慢的自发振荡，部分归因于交感神经活动的变化（M波，每分钟3至9个周期）和脑干中单胺能神经元的放电（B波，每分钟0.5至2个周期）。方法对27例癫痫患者（9例原发性全身性癫痫，18例局灶性癫痫）进行头皮脑电图（电极按10-20系统放置）和双侧大脑中动脉经颅多普勒（TCD）同步记录。CBFV的数据分析是基于多普勒频谱的包络曲线。对20 min CBFV曲线进行快速傅立叶变换，计算B波和M波振幅，并与20例年龄匹配的正常对照组进行比较。局灶性癫痫患者的正常半球和癫痫灶侧之间的M波和B波均不存在不对称性。结论癫痫患者的M波增强可能反映了交感神经活动的增加，即使在没有癫痫发作的情况下。这项研究提供了进一步的证据，植物神经功能障碍作为癫痫患者不明原因猝死的可能机制。
Background and Purpose Cardiac arrhythmias mediated by the sympathetic nervous system have been implicated in sudden, unexplained deaths in patients with epilepsy. Cerebral blood flow velocities (CBFV) as measured by transcranial Doppler are characterized by slow spontaneous oscillations in part attributed to changes in sympathetic activity (M waves, 3 to 9 cycles per minute) and to discharges of monoaminergic neurons in the brain stem (B waves, 0.5 to 2 cycles per minute). This study was designed to compare spontaneous fluctuations of CBFV in patients with epilepsy with those in normal control subjects.Methods Simultaneous registrations of scalp electroencephalograms, with electrodes placed according to the 10-20 System, and transcranial Doppler recordings of both middle cerebral arteries were performed in 27 patients (9 with primary generalized epilepsy, 18 with focal epilepsy). Data analysis of CBFV was based on the envelope curves of the Doppler spectrum. A fast Fourier transformation over the 20-minute CBFV curve was performed, and the amplitudes of B and M waves were calculated and compared with those in 20 normal, age-matched control subjects.Results While the amplitudes of the B waves in both groups were similar, patients with epilepsy showed significantly in creased M waves. Patients with focal epilepsy did not present asymmetries between the normal hemisphere and the side of the epileptic focus with respect to both M and B waves.Conclusions Enhanced M waves in epileptic patients may reflect increased sympathetic activity even in the absence of seizures. This study provides further evidence for an autonomic dysfunction as a possible mechanism for sudden unexplained death in patients with epilepsy.