Comparison of Autonomic Function before and after Surgical Intervention in Patients with Temporal Lobe Epilepsy.
Comparison of Autonomic Function before and after Surgical Intervention in Patients with Temporal Lobe Epilepsy.
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DOI：
10.14581/jer.17014
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发表时间：
2017-12
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影响因子：
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通讯作者：
Tripathi M
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作者：
Choudhary N;Deepak KK;Chandra PS;Bhatia S;Sagar R;Jaryal AK;Pandey RM;Tripathi M
难治性颞叶癫痫（TLE）通常与心血管（CV）副交感神经和交感神经功能失衡有关，可通过TLE手术治疗。我们研究了癫痫病灶半球偏侧对TLE手术前后自主神经功能的影响。研究对象为行单侧TLE手术的左TLE （LTLE, n = 23）和右TLE （RTLE, n = 30）患者。为了评估自主心血管功能，在术前和术后3个月和6个月，使用标准化的自主神经反应性测试电池测量心率（ΔHR）和血压（BP）的变化。术前，LTLE组的ΔHR及深呼吸试验时呼气吸气比（E:I）均高于RTLE组（p < 0.001），但两组在3个月和6个月时的结果具有可比性。与术前相比，ΔHR在3个月和6个月时下降（p分别< 0.001和0.01）。LTLE组3个月时E:I低于术前（p = 0.04）。术前俯仰试验时，LTLE组收缩压下降幅度大于RTLE组（p = 0.002）。RTLE组6个月时冷压试验时的最大舒张压升高值低于术前（p = 0.001），而LTLE组的最大舒张压升高值低于术前（p = 0.002）。我们发现，手术前颞叶癫痫病灶的半球偏侧对自主神经CV功能有不同的影响。术前，LTLE组副交感神经反应性较高，RTLE组交感神经反应性较高。手术后，自主心血管功能在两组之间具有可比性，表明TLE手术稳定了自主心血管功能。
Refractory temporal lobe epilepsy (TLE) is commonly associated with imbalances in cardiovascular (CV) parasympathetic and sympathetic functions, which are treated using TLE surgery. We investigated the effect of hemispheric lateralization of seizure foci on autonomic CV functions before and after TLE surgery. The study was conducted on patients with left TLE (LTLE, n = 23) and right TLE (RTLE, n = 30) undergoing unilateral TLE surgery. To assess the autonomic CV functions, changes in the heart rate (ΔHR) and blood pressure (BP) were measured using a standardized battery of autonomic reactivity tests before surgery and at 3 and 6 months after surgery. Before surgery, ΔHR and the expiration to inspiration ratio (E:I) during the deep breathing test were higher in the LTLE group than in the RTLE group (both p < 0.001), but both outcomes were comparable between the groups at 3 and 6 months. ΔHR decreased at 3 and 6 months (p < 0.001 and 0.01, respectively) compared with preoperative values. The E:I at 3 months in the LTLE group was lower (p = 0.04) than the preoperative values. Decrease in systolic BP during the head-up tilt test was greater in the LTLE group than in the RTLE group (p = 0.002) before surgery. The maximum increase in diastolic BP during the cold pressor test was lower in the RTLE group at 6 months than that before surgery (p = 0.001) and in the LTLE group (p = 0.002). We found that hemispheric lateralization of seizure foci in the temporal lobe had a differential effect on autonomic CV functions before surgery. Before surgery, parasympathetic reactivity was higher in the LTLE group, and sympathetic reactivity was higher in the RTLE group. After surgery, autonomic CV functions were comparable between the groups, suggesting that TLE surgery stabilizes autonomic CV functions.