Abstract Details

Title Novel Heart Rate Anaylsis Distinguishes TLE Patients from Patients with Non-Epileptic Seizures

Topic Epilepsy

Presentation(s) P07 - (-)

Poster/Presentation
Number 168

Objective

Background BACKGROUND: Autonomic cardiac dysfuction is reported in patients with TLE, manifesting as heart rate abnormalities. However, reports measuring HR using frequency-domain analysis (fourier transformation) have not controlled for respiratory arrhythmia and yielded conflicting results. As biological systems normally show characteristics of variability which can be mathematically quantified as non-linear entropy, we hypothesize that by measuring the entropy of cardiac rhythms, we can distinguish TLE patients from those with non-epileptic seizures.

Design/Methods DESIGN/METHODS: We retrospectively identified (2003-2008) two groups of patients from our epilepsy monitoring unit (EMU). All patients with diagnosed cardiovascular morbidities were excluded. Our experimental group consisted of patients with confirmed right TLE through a seizure free outcome after temporal lobectomy, and our controls of patients with electroencephalographically confirmed pseudoseizures. For each patient we extract three 120s periods (awake, sleep state and proceeding seizure onset) from EMU files that recorded EEG and EKG simultaneously. We used phase portraits to describe the oscillatory nature of cardiac dynamics, and quantify the coupling between cardiac and respiratory systems.

Results RESULTS: Five patients were included in the control pseudoseizure group (4 women; mean age 31±12years) and four patients in the right TLE group (3 women; mean age 32±15years). TLE patients had higher average entropy value (S = 4.5) than the pseudoseizure group (S = 2.5) in all three states. Calculation of the approximate entropy for each state of consciousness showed distinct peaks for each group.

Conclusions CONCLUSIONS: This simple noninvasive investigation of HR distinguishes epileptic from non-epileptic patients. The higher entropy values seen in TLE signify higher rates of HR fluctuations in comparison to autonomic "healthy" patients. The dynamics of coupled phase oscillators provides the framework to characterize the nonlinear behavior associated with dysautonomia in patients with TLE .

Authors/Disclosures
Rebecca O'Dwyer, MD (Rush University Medical Center) PRESENTER	Dr. O'Dwyer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. O'Dwyer has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for SK Life Sciences.
	No disclosure on file
Steven Levine, MD, FAHA (SUNY Downstate Medical Center)	Dr. Levine has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MEDLINK. Dr. Levine has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Law Firms. The institution of Dr. Levine has received research support from NIH.
	No disclosure on file
	No disclosure on file
Aashit K. Shah, MD, FAAN (Carilion Clinic)	Dr. Shah has stock in Abbot, Abbivie, Gilead, Johnson and Johnson, Pfizer. The institution of Dr. Shah has received research support from Xenon Pharma.
Richard C. Burgess, MD, PhD (Cleveland Clinic, Dept of Neurology)	Dr. Burgess has nothing to disclose.

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