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Background: Epilepsy patients may have an impaired autonomic cardiac control, which has been associated with an increased incidence of sudden unexpected death among people with epilepsy (SUDEP). The risk of SUDEP is particularly high among epilepsy surgery candidates with refractory epilepsy. This risk seems to be reduced after successful surgery but whether this is an effect of surgery or refle cts pre-existing differences between good and poor responders is under debate. Methods: We used spectral analysis to analyze prospectively heart rate variabili ty (HRV) preoperatively in 21 consecutive patients with temporal lobe epilepsy w ho were planned for epilepsy surgery. The presurgical HRV based on ambulatory 24 hours EKG recordings was analyzed in relation to seizure control at 1 year afte r surgery. Results: Patients had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. Patient s with good outcome of surgery (Engel class I; n = 11)-did not differ from thei r controls while those with poor outcome (Engel class II-IV; n = 10) had signif icantly lower power in all domains than those with a favorable outcome. Conclusi ons: Measurements of heart rate variability preoperatively indicate that patient s with a poor outcome of surgery have a more pronounced impairment of sympatheti c as well as parasympathetic cardiac control than those with good outcome. Reduc ed heart rate variability may be associated with an increased risk of sudden une xpected death among people with epilepsy (SUDEP). Good surgery candidates may a priori have a lower risk of SUDEP.
Background: Epilepsy patients may have an impaired autonomic cardiac control, which has been associated with an increased incidence of sudden unexpected death among people with epilepsy (SUDEP). The risk of SUDEP is particularly high among epilepsy surgery candidates with refractory epilepsy. This risk of SUDEP is particularly high among epilepsy surgery candidates with refractory epilepsy. to be reduced after successful surgery but whether this is an effect of surgery or refle cts pre-existing differences between good and poor responders is under debate. Methods: We used spectral analysis to analyze prospectively heart rate variabili ty (HRV) preoperatively in 21 consecutive patients with temporal lobe epilepsy w ho were planned for epilepsy surgery. The presurgical HRV based on ambulatory 24 hours EKG recordings was analyzed in relation to seizure control at 1 year afte r surgery. Results: Patients had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. Patient s with good outcome of su rgery (Engel class I; n = 11) -did not differ from the r r controls while those with poor outcome (Engel class II-IV; n = 10) had signif icantly lower power in all domains than those with a favorable outcome. Conclusi ons: Measurements of heart rate variability preoperatively indicate that patient s with a poor outcome of surgery have a more pronounced impairment of sympatheti c as well as parasympathetic cardiac control than those with good outcome. Reduc ed heart rate variability may be associated with an increased risk of sudden unexpected death among people with epilepsy (SUDEP). Good surgery candidates may a priori have a lower risk of SUDEP.