首页|局灶性癫痫围发作期心率变异性变化特点

局灶性癫痫围发作期心率变异性变化特点

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目的 探讨局灶性癫痫围发作期心率变异性变化特点。方法 收集2014年9月至2019年9月在首都医科大学附属北京天坛医院癫痫中心进行术前评估并完成手术的癫痫患者102例，选择局灶性发作198次，手动测量相邻两个心电活动的RR间期，计算心率变异性时域参数-相邻正常心跳间期差值平方和的均方根(RMSSD)，比较发作前60 s、发作期、终止后60 s RMSSD差异，并比较不同心率变化类型、不同发作类型、不同发作前状态以及不同致痫灶部位和侧别RMSSD差异。结果 发作期和发作前60 s及终止后60 s RMSSD相比差异有统计学意义(P＜0。001)，提示发作期RMSSD降低;心率增快类型癫痫发作期RMSSD降低(P＜0。001);复杂部分性癫痫发作期RMSSD降低(P＜0。001);颞叶内侧癫痫发作期RMSSD降低(右颞叶内侧P＜0。001;左颞叶内侧P＜0。001);心率无变化(P=0。556)和心率减慢(P=0。983)类型癫痫发作、单纯部分性癫痫(P=0。869)、颞叶外侧癫痫(右颞叶外侧P=0。204;左颞叶外侧P=0。849)和颞叶外癫痫(右颞外P=0。188;左颞外P=0。068)发作期RMSSD无降低。发作期和发作前60 s RMSSD差值在睡眠期更明显(P=0。039)。结论 心率增快类型癫痫发作、复杂部分性癫痫、颞叶内侧癫痫发作期易发生心率变异性下降，提示癫痫发作期副交感活性下降;睡眠期状态下发生的癫痫发作期心率变异性下降相比清醒期显著，提示睡眠期癫痫发作副交感活性下降更加明显。
Characteristics of Heart Rate Variability During the Peri-ictal Period in Focal Epilepsy
Objective To explore the characterization of heart rate variability during the peri-ictal period in focal epilepsy.Methods A total of 102 patients with focal epilepsy who underwent preoperative evaluation and completed surgery at the Epilepsy Center of Beijing Tiantan Hospital,Capital Medical University from September 2014 to September 2019 were collected.A total of 198 focal seizures were selected.RR intervals of two adjacent electrocardiograph activities were measured manually,and the square root of the mean squared differences of successive NN intervals(RMSSD)was calculated.RMSSD differences were compared 60 seconds before onset,during ictal period and 60 seconds after termination.The difference of RMSSD among different types of heart rate change,different seizure types,different pre-ictal states,and different sites and sides of epileptic focus were compared.Results There were significant differences in RMSSD among the ictal period and 60 seconds before the onset and 60 seconds after the termination(P＜0.001),suggesting decrease in RMSSD during the ictal period.The RMSSD was decreased during the ictal period of seizures with increased heart rate(P＜0.001).RMSSD decreased in complex partial seizures(P＜0.001).RMSSD decreased in medial temporal lobe epilepsy(the right medial temporal lobe epilepsy P＜0.001,the left medial temporal lobe epilepsy P＜0.001).There was no significant decrease in RMSSD in seizures with no change in heart rate(P=0.556)or in seizures with decreased heart rate(P=0.983),simple partial seizures(P=0.869),lateral temporal lobe epilepsy(the right lateral temporal lobe epilepsy P=0.204,the left lateral temporal lobe epilepsy P=0.849)and extratemporal lobe epilepsy(the right extratemporal lobe epilepsy P=0.188,the left extratemporal lobe epilepsy P=0.068).The RMSSD difference between ictal period and 60 seconds before onset was more in sleep phase(P=0.039).Conclusion The decrease of heart rate variability was easy to occur in the ictal period of seizures with increased heart rate,complex partial seizures and medial temporal lobe epilepsy,suggesting that parasympathetic activity decreased during the ictal period.The decrease of heart rate variability during the sleep phase was more significant than that during the awake phase,suggesting that parasympathetic activity decreased more significantly during the sleep phase.

focal epilepsyheart rate variabilitythe square root of the mean squared differences of successive NN intervalsmedial temporal lobe epilepsylateral temporal lobe epilepsyextratemporal lobe epilepsy

孙建奎、王群

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安阳地区医院神经内一科,河南安阳 455000

首都医科大学附属北京天坛医院神经病学中心,北京 100070

局灶性癫痫 心率变异性 相邻正常心跳间期差值平方和的均方根 颞叶内侧癫痫 颞叶外侧癫痫 颞叶外癫痫

国家重点研发计划项目首都卫生发展科研专项项目

2017YFC13075012016-1-2011

2024

10.3969/j.issn.1004-437X.2024.07.008

河南医学研究
河南省医学科学院

河南医学研究

影响因子：0.979
ISSN：1004-437X
年,卷(期)：2024.33(7)
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