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Arrhythm Electrophysiol Rev 2020 Jun;9(1):40-46

Cardiovascular Section, Department of Internal Medicine, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, US.

Low-level tragus stimulation (LLTS) is a non-invasive approach of transcutaneous vagus nerve stimulation. LLTS has applications in diseases of multiple systems, including epilepsy, depression, headache and potentially several cardiovascular diseases. LLTS has shown promising results in suppressing AF, alleviating post-MI ventricular arrhythmias and ischaemia-reperfusion injury along with improving diastolic parameters in heart failure with preserved left ventricular ejection fraction (HFpEF). Read More

Seizure 2020 Jul 2;80:201-211. Epub 2020 Jul 2.

Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel. Electronic address:

Despite progress in the development of anti-seizure drugs, drug-resistant epilepsy (DRE) occurs in a third of patients. DRE is associated with poor quality of life and increased risk of sudden, unexplained death. The autonomic nervous system and chronobiology play a role in DRE. Read More

Diagnostics (Basel) 2020 Jun 9;10(6). Epub 2020 Jun 9.

School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy.

Epilepsy is a group of neurological disorders characterized by abnormal electrical activity in the central nervous system (CNS) and recurrent seizures representing the principal clinical manifestation. Sudden unexpected death in epilepsy (SUDEP) is the predominant cause of death in young epileptic patients. SUDEP patients displayed an increased cardiovascular (CV) risk, probably due to an impaired autonomic control of CV functions, but the underlying mechanisms need to be explored yet. Read More

Epilepsy Behav 2020 May 27;110:107144. Epub 2020 May 27.

Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, Tampere FI-33521, Finland; Tampere University, Faculty of Medicine and Health Technology, FI-33014 Tampere, Finland.

Background: Responsive vagus nerve stimulation (rVNS) utilizes an electrocardiograph (ECG)-based algorithm to detect rapid sympathetic activations associated with the onset of a seizure. Abrupt sympathetic activation may also be associated with nocturnal arousals between sleep cycles or transitioning from sleep to wakefulness, a period in which many patients with epilepsy experience seizures. Because of circadian changes in autonomic function, we hypothesized that the autostimulation feature might also behave in a circadian fashion. Read More

Biomed Eng Online 2020 May 29;19(1):40. Epub 2020 May 29.

Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, 100853, China.

Background: Cervical vagus nerve stimulation (VNS) has been widely accepted as adjunctive therapy for drug-resistant epilepsy and major depression. Its effects on glycemic control in humans were however poorly understood. The aim of our study was to investigate the potential effects of VNS on fasting blood glucose (FBG) in patients with drug-resistant epilepsy. Read More

Zhongguo Dang Dai Er Ke Za Zhi 2020 May;22(5):488-493

Department of Pediatrics, Second Xiangya Hospital of Central South University, Changsha 410011, China.

Objective: To study the clinical features of vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) in children with neurological symptoms at disease onset.

Methods: A retrospective analysis was performed on the medical data of 88 children with the initial symptoms of the nervous system, such as transient loss of consciousness, dizziness, headache, and convulsion, who were finally diagnosed with VVS or POTS.

Results: Of the 88 children, there were 35 boys (40%) and 53 girls (60%), with an age of 4-15 years. Read More

Biomedicines 2020 May 8;8(5). Epub 2020 May 8.

Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Selangor, Malaysia.

Experimental and clinical studies of cardiac pathology associated with epilepsy have demonstrated an impact on the autonomic nervous system (ANS). However, the underlying molecular mechanism has not been fully elucidated. Molecular investigation of the neurotransmitters related receptor and ion channel directing ANS might help in understanding the associated mechanism. Read More

Epilepsy Behav 2020 May 1;106:107041. Epub 2020 Apr 1.

Department of Physical Education, Faculty of Educational Sciences and Teachers' Training, An-Najah National University, Nablus, Palestine.

Objectives: Yoga is believed to play a role in stabilizing the electroencephalogram and the autonomic nervous system, thus might help control seizures in people with epilepsy (PWE). This qualitative study was conducted to explore experiences of Palestinian PWE with regard to benefits, motives, barriers, and recommendations of prescribing yoga exercises as a nonpharmacological intervention.

Methods: Purposive and snowball sampling techniques were used to recruit PWE who practiced yoga. Read More

Epilepsy Behav 2020 Apr 25;105:106946. Epub 2020 Feb 25.

Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America.

Sudden unexpected death in epilepsy (SUDEP) is generally considered to result from a seizure, typically convulsive and usually but not always occurring during sleep, followed by a sequence of events in the postictal period starting with respiratory distress and progressing to eventual cardiac asystole and death. Yet, recent community-based studies indicate a 3-fold greater incidence of sudden cardiac death in patients with chronic epilepsy than in the general population, and that in 66% of cases, the cardiac arrest occurred during routine daily activity and without a temporal relationship with a typical seizure. To distinguish a primarily cardiac cause of death in patients with epilepsy from the above description of SUDEP, we propose the concept of the "Epileptic Heart" as "a heart and coronary vasculature damaged by chronic epilepsy as a result of repeated surges in catecholamines and hypoxemia leading to electrical and mechanical dysfunction. Read More

Pediatr Neurol 2020 05 20;106:4-9. Epub 2019 Dec 20.

Division of Child Neurology, Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York.

Cyclic vomiting syndrome is an idiopathic chronic periodic disorder of childhood which may persist into the adult years. Although cyclic vomiting syndrome is considered a central nervous system disorder, it is often managed by a pediatric gastroenterologist. The practitioner should not assume a gastrointestinal or non-neurological cause of symptoms especially if there are coexisting neurological symptoms and signs or if vomiting does not bring relief; this suggests a possible central nervous system cause, which may necessitate a pediatric neurology consultation. Read More

J Peripher Nerv Syst 2020 Jun 6;25(2):117-124. Epub 2020 Mar 6.

Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK.

KIF1A-related disorders (KRD) were first described in 2011 and the phenotypic spectrum has subsequently expanded to encompass a range of central and peripheral nervous system involvement. Here we present a case series demonstrating the range of clinical, neurophysiological, and radiological features which may occur in childhood-onset KRD. We report on all the children and young people seen at a single large tertiary centre. Read More

Conf Proc IEEE Eng Med Biol Soc 2019 07;2019:6776-6779

Epileptic seizures are by default associated with the occurrence of EEG changes as a consequence of alterations in brain activity seconds to hours before the seizure onset. Additionally, the influence of the autonomic nervous system may also be reflected in the electrocardiogram (ECG) trace. In both biosignals (EEG and ECG), differences have been reported between normal epochs, known as interictal periods and the interval preceding seizures, preictal period. Read More

Conf Proc IEEE Eng Med Biol Soc 2019 07;2019:3502-3506

Differentiating epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) is commonly based on electroencephalogram and concurrent video recordings (vEEG). Here, we demonstrate that these two types of seizures can be discriminated based on signals related to autonomic nervous system activity recorded via wearable sensors. We used Empatica E4 Wristband sensors worn on both arms in vEEG confirmed seizures, and machine learning methods to train classifiers, specifically, extreme gradient boosting (XGBoost). Read More

J Clin Neurophysiol 2019 Nov;36(6):437-442

Medical Faculty, University of Erlangen-Nuremberg, Erlangen, Germany.

Invasive vagus nerve stimulation (VNS) is an approved treatment for drug-resistant epilepsy. Besides recognized clinical efficacy in about 60% of patients, there are major drawbacks such as invasiveness and common side effects including hoarseness, sore throat, shortness of breath, and coughing. Invasive VNS applies electrical stimulation to the left cervical branch of the vagus nerve and excites thick-myelinated afferent nerve fibers. Read More

Nervenarzt 2019 Dec;90(12):1221-1231

Epilepsiezentrum, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.

Wearables are receiving much attention from both epilepsy patients and treating physicians, for monitoring of seizure frequency and warning of seizures. They are also of interest for the detection of seizure-associated risks of patients, for differential diagnosis of rare seizure types and prediction of seizure-prone periods. Accelerometry, electromyography (EMG), heart rate and further autonomic parameters are recorded to capture clinical seizure manifestations. Read More

Neurology 2019 11 23;93(21):932-938. Epub 2019 Oct 23.

From the Department of Neurology, Mayo Clinic, Rochester, MN.

Physiol Meas 2019 12 2;40(11):114001. Epub 2019 Dec 2.

Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany.

Background: A multitude of complex methods is available to quantify interactions in highly complex physiological systems. Brain-heart interactions play an important role in identifying couplings between the central nervous system and the autonomic nervous system during defined physiological states or specific diseases. The crucial point of those interaction analyses is adequate pre-processing taking into account nonlinearity of data, intuitive graphical representation and suitable statistical evaluation of the achieved results. Read More

Epilepsia 2019 10 20;60(10):2105-2113. Epub 2019 Sep 20.

Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.

Objective: To assess the feasibility and accuracy of seizure detection based on heart rate variability (HRV) using a wearable electrocardiography (ECG) device. Noninvasive devices for detection of convulsive seizures (generalized tonic-clonic and focal to bilateral tonic-clonic seizures) have been validated in phase 2 and 3 studies. However, detection of nonconvulsive seizures still needs further research, since currently available methods have either low sensitivity or an extremely high false alarm rate (FAR). Read More

Brain 2019 10;142(10):2948-2964

Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, UK.

Axon pathfinding and synapse formation are essential processes for nervous system development and function. The assembly of myelinated fibres and nodes of Ranvier is mediated by a number of cell adhesion molecules of the immunoglobulin superfamily including neurofascin, encoded by the NFASC gene, and its alternative isoforms Nfasc186 and Nfasc140 (located in the axonal membrane at the node of Ranvier) and Nfasc155 (a glial component of the paranodal axoglial junction). We identified 10 individuals from six unrelated families, exhibiting a neurodevelopmental disorder characterized with a spectrum of central (intellectual disability, developmental delay, motor impairment, speech difficulties) and peripheral (early onset demyelinating neuropathy) neurological involvement, who were found by exome or genome sequencing to carry one frameshift and four different homozygous non-synonymous variants in NFASC. Read More

Epilepsy Behav 2019 10 17;99:106468. Epub 2019 Aug 17.

Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.

World Neurosurg 2019 Nov 10;131:180-185. Epub 2019 Aug 10.

Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany; Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany.

Background: Vagus nerve stimulation (VNS) has become an increasingly popular procedure for the treatment of epilepsy and depression. Significant complications or side effects associated with VNS surgery may result from either the inadvertent direct injury to the vagus nerve as part of the surgical approach, placement of the electrode, or the concomitant stimulation of vagal efferent fibers. To mitigate these effects, the recognition of anatomic variants that may place the nerve at increased risk is necessary. Read More

World Neurosurg 2019 Nov 5;131:191-193. Epub 2019 Aug 5.

Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan. Electronic address:

Background: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy; however, the misplacement of electrodes may cause complications and thus needs to be avoided.

Methods: We herein report an intraoperative monitoring technique to prevent the misplacement of electrodes. Endotracheal tube electrodes were inserted to record electromyographic activity from the vocal cords and identify the vagus nerve. Read More

Epilepsia 2019 09 29;60(9):2003-2005. Epub 2019 Jul 29.

Pediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.

J Neuroimmunol 2019 10 18;335:577008. Epub 2019 Jul 18.

Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Italy; Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padova, Italy.

Leucine-rich glioma-inactivated protein 1 (LGI1) and contactin-associated protein-like 2 (CASPR2) neurological autoimmunity in adults has been associated with various clinical syndromes involving central, peripheral and autonomic nervous system, while data in children is limited. We perform the first systematic literature review on paediatric LGI1 and CASPR2 autoimmunity, with focus on clinical data, in order to contribute to the definition of clinical features of LGI1 and CASPR2 autoimmunity in paediatric age and favour early diagnosis. Additionally, we report the youngest-to-date case of Morvan syndrome. Read More

Curr Pharm Des 2019 ;25(26):2892-2905

Faculty of Science, The University of Jordan, Amman, 11942, Jordan.

Adenosine is a naturally occurring nucleoside and an essential component of the energy production and utilization systems of the body. Adenosine is formed by the degradation of adenosine-triphosphate (ATP) during energy-consuming processes. Adenosine regulates numerous physiological processes through activation of four subtypes of G-protein coupled membrane receptors viz. Read More

Auton Neurosci 2019 09 15;220:102554. Epub 2019 Jun 15.

Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland; Department of Neurology, Bern University Hospital, Bern, Switzerland. Electronic address:

Multiple mechanisms may modulate an association between restless legs syndrome/Willis-Ekbom disease (RLS/WED) and cardiovascular disease (CVD), including chronic sleep deprivation, intermittent, periodic limb movements in sleep (PLMS)-related autonomic fluctuations and possible autonomic dysfunction intrinsically associated with RLS per se. The purpose of this paper is to review the existing RLS/WED literature focusing on the pathophysiologic evidence for possible associations between RLS/WED and PLMS with CVD and events (CVE). Specific intrinsic dysautonomic aspects of the disease, which may contribute to generating CVD, are separately discussed. Read More

Seizure 2019 Oct 2;71:105-109. Epub 2019 Jul 2.

Medical Sciences Post-graduate Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil. Electronic address:

In this article, we explore the interaction of brain and heart in patients with epilepsy (PWE), focusing on new insights into possible pathways from epilepsy, catecholaminergic toxicity, subtle cardiac changes and sudden death. Initial evidence and biological plausibility point to an interaction between autonomic dysfunction, higher sympathetic drive, myocardial catecholaminergic toxicity and cardiac fibrosis resulting in subtle myocardial changes in structure, function, arrhythmogenesis and/or a heart failure-like phenotype in PWE. Non invasive imaging and biomarkers of cardiac injury and fibrosis are emerging as possible diagnostic tools to better stratify the risk of such individuals. Read More

Epilepsy Res 2019 09 12;155:106156. Epub 2019 Jun 12.

Departments of Neurology and South Texas Comprehensive Epilepsy Center, UT Health San Antonio, San Antonio, TX, United States.

The epileptic baboon provides a natural model of idiopathic generalized epilepsy and sudden unexpected death in epilepsy (SUDEP). We sought to evaluate autonomic differences, including heart rate (HR), heart rate variability (HRV) and corrected QT-duration (QTc) between two epileptic (EB1, EB2) and one control (CB) baboon, and the autonomic effects of high-frequency (HF) microburst Vagal Nerve Stimulation (VNS) Therapy in the epileptic baboons. At baseline, EB2's HR was increased over both EB1 and CB, and EB1's HRV was decreased compared to the others. Read More

Epilepsy Behav 2019 08 27;97:260-264. Epub 2019 Jun 27.

Epilepsy Center, UT Health Sciences Center Houston (Texas), USA; NINDS Center for SUDEP Research (CSR), USA.

Objective: The aim of this study was to determine if insular damage is associated with markers of autonomic dysfunction.

Methods: We studied patients who underwent temporal lobe and/or insular resections for epilepsy surgery between April 2010 and June 2015 at University Hospitals Cleveland Medical Center (UHCMC). Presurgical T1-weighted MPRAGE, standard T1, T2 and FLAIR sequences were compared with postsurgical MRI by a neuroradiologist and classified as type 0 (no involvement of insula), type 1 (minimal involvement of insular margin), type 2 (insular involvement <25%), and type 3 (insular involvement ≥25%). Read More

Epilepsy Behav 2019 08 25;97:161-168. Epub 2019 Jun 25.

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address:

Objectives: The objectives of this study were to determine how hemispheric laterality of seizure activity influences periictal heart rate variability (HRV) and investigate the ability of HRV parameters to discriminate right- and left-sided seizures.

Methods: Long-term video electroencephalogram-electrocardiogram recordings of 54 focal seizures in 25 patients with focal epilepsy were reviewed. Using linear mixed models, we examined the effect of seizure laterality on linear (standard deviation of R-R intervals [SDNN], root mean square of successive differences [RMSSD], low frequency [LF] and high frequency [HF] power of HRV, and LF/HF) and nonlinear (standard deviation [SD]1, SD2, and SD2/SD1 derived from Poincaré plots) periictal HRV parameters, the magnitude of heart rate (HR) changes, and the onset time of increased HR. Read More

Intractable Rare Dis Res 2019 May;8(2):134-137

Department of Pediatrics and Central Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University School of Medicine, Fukuoka, Japan.

Alternating hemiplegia of childhood (AHC) is a rare disorder characterized by repetitive episodes of transient hemiplegia. Although autonomic nervous system dysfunction is believed to be associated with AHC, there are no reports of heart rate variability (HRV) in patients with AHC. In the current study, we analyzed HRV in a 20-year-old female with this disorder. Read More

J Comp Neurol 2019 12 14;527(18):3014-3022. Epub 2019 Jun 14.

Faculty of Medicine, Geneva University, Geneva, Switzerland.

The dorsal anterior cingulate cortex (dACC) and the anterior insula (AI) constitute the salience network and form as well the major cortical components of the central autonomic nervous system. These two cortical regions have the highest density in α4β2 nicotinic acetylcholine receptors (nAChRs) within the whole cortex.The aim of the study was to test the association between nAChRs density/availability in the salience network and the heart rate variability in humans. Read More

Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2019 May;40(1):5-40

Macedonian Academy of Sciences and Arts, Skopje, Republic of Macedonia.

Background: Fearful and anxious behaviour is especially common in children, when they come across new situations and experiences. The difference between normal worry and an anxiety disorder is in the severity and in the interference with everyday life and normal developmental steps. Many longitudinal studies in children suggest that anxiety disorders are relatively stable over time and predict anxiety and depressive disorders in adolescence and adulthood. Read More

Pediatr Neurol 2019 08 27;97:38-42. Epub 2019 Mar 27.

Children's Hospital Colorado and University of Colorado School of Medicine Aurora, Colorado; Department of Pediatrics, Aurora, Colorado; Department of Pharmacology, Aurora, Colorado; Department of Neurology, Aurora, Colorado; Department of Otolaryngology, Aurora, Colorado. Electronic address:

Background: Pathologic mutations in cyclin-dependent kinase-like 5 cause CDKL5 deficiency disorder, a genetic syndrome associated with severe epilepsy and cognitive, motor, visual, and autonomic disturbances. This disorder is a relatively common genetic cause of early-life epilepsy. A specific severity assessment is lacking, required to monitor the clinical course and needed to define the natural history and for clinical trial readiness. Read More

Front Neurol 2019 14;10:501. Epub 2019 May 14.

Department of Epileptology, University Hospital Bonn, Bonn, Germany.

In this narrative review, we summarize the current knowledge of neurally mediated blood pressure (BP) control and discuss how recently described epilepsy- and seizure-related BP alterations may contribute to premature mortality and sudden unexpected death in epilepsy (SUDEP). Although people with epilepsy display disturbed interictal autonomic function with a shift toward predominant sympathetic activity, prevalence of arterial hypertension is similar in people with and without epilepsy. BP is transiently increased in association with most types of epileptic seizures but may also decrease in some, illustrating that seizure activity can cause both a decrease and increase of BP, probably because of stimulation or inhibition of distinct central autonomic function by epileptic activity that propagates into different neuronal networks of the central autonomic nervous system. Read More

Epilepsy Behav 2019 07 14;96:69-79. Epub 2019 May 14.

Institute of Sports Medicine, Department Sports & Health, Paderborn University, Paderborn, Germany; Edward B. Bromfield Epilepsy Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. Electronic address:

The goal of this study was to evaluate and summarize the current literature on multimodal changes of the autonomic nervous system (ANS) in people with epilepsy (PWE). We included studies reporting ANS measures of at least two modalities and with a minimum of one group of people with epilepsy. We screened two hundred eighty-three abstracts and sixty-six full texts, of which twenty-two met our inclusion criteria. Read More

Int J Neurosci 2019 Oct 9;129(10):1013-1023. Epub 2019 Aug 9.

School of Biological Sciences, University of Southampton , Southampton , UK.

The effective treatment of many diseases requires the use of multiple treatment strategies among which neuromodulation is playing an increasingly important role. Neuromodulation devices that act to normalize or modulate nerve activity through the targeted delivery of electrical stimuli will be the focus of this review. These devices encompass deep brain stimulators, vagus nerve stimulators, spinal cord simulators and sacral nerve stimulators. Read More

World Neurosurg 2019 Jul 14;127:370-374. Epub 2019 Apr 14.

Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies.

The carotid sinus nerve branches off the glossopharyngeal nerve just after its appearance from the jugular foramen, descends along the internal carotid artery, and enters the carotid sinus. There have been many studies of the pathway and the course of the carotid sinus nerve and its communications with surrounding nerves. The intercommunication is exceedingly complicated. Read More

Seizure 2019 Jul 3;69:77-79. Epub 2019 Apr 3.

Department of Neurosurgery, Charité University Hospital, Berlin, Germany.

Purpose: Vagus nerve stimulation (VNS) is well established in the treatment of epilepsy and disorders of depression. The prevalence of depression is high in patients with epilepsy, but still it remains unclear how patients with a comorbidity of epilepsy and symptoms of depression respond to VNS.

Methods: We investigated 59 patients with different subtypes of disorders of depression as a comorbidity of epilepsy, who underwent VNS-surgery. Read More

Dev Period Med 2019 ;23(1):28-33

Klinika Pediatrii Alergologii i Gastroenterologii Collegium Medicum w Bydgoszczy, Uniwersytet Mikołaja Kopernika w Toruniu, Polska.

Vomiting is a common sign of illness in the pediatric population. Its etiology is diversified, ranging from mild functional disorders to severe life-threatening systemic diseases. Vomiting most often occurs in the course of gastrointestinal tract diseases, however, it may also coexist with numerous other ailments located outside the GI tract. Read More

Epilepsy Res 2019 07 26;153:83-84. Epub 2019 Feb 26.

Epilepsy Center Frankfurt Rhine-Main, Dept. of Neurology, University of Frankfurt, Germany. Electronic address:

Transcutaneous vagus nerve stimulation (tVNS) is a newly developed method which intends to overcome the disadvantage of surgical implantation of the stimulation device. The tVNS device is designed to stimulate the auricular branch of the vagus nerve via a bipolar electrode attached to the skin of the left ear conch. A randomized, double-blind controlled trial assessed efficacy and safety over 20 weeks of tVNS (n=39) vs. Read More

Physiol Meas 2019 07 23;40(7):074003. Epub 2019 Jul 23.

Dipartimento di Ingegneria, Università degli Studi di Palermo, Palermo, Italy.

Objective: In this work we explore the potential of combining standard time and frequency domain indexes with novel information measures, to characterize pre- and post-ictal heart rate variability (HRV) in epileptic children, with the aim of differentiating focal and generalized epilepsy regarding the autonomic control mechanisms.

Approach: We analyze short-term HRV in 37 children suffering from generalized or focal epilepsy, monitored 10 s, 300 s, 600 s and 1800 s both before and after seizure episodes. Nine indexes are computed in time (mean, standard deviation of normal-to-normal intervals, root mean square of the successive differences (RMSSD)), frequency (low-to-high frequency power ratio LF/HF, normalized LF and HF power) and information (entropy, conditional entropy and self-entropy) domains. Read More

Seizure 2019 Jul 9;69:7-10. Epub 2018 Jul 9.

Cardiopulmonary Research Center, Shaheed Beheshti University of Medical Science, Tehran, Iran.

Purpose: Previous studies suggested the possible role of autonomic dysfunction in sudden unexpected death in epilepsy (SUDEP). The aim of this study is to assess the interictal ECG alternations especially heart rate variability (HRV), as a marker of autonomic dysfunction, in patients with drug-resistant epilepsy and determine the effect of epilepsy type and duration, seizure frequency and anti-epileptic drugs (AEDs) on ECG findings.

Methods: In this comparative cross-sectional study, the interictal ECG parameters of 64 consecutive patients with drug-resistant epilepsy and the same number of age and sex-matched controls were analyzed. Read More

Neuroimage Clin 2019 12;22:101763. Epub 2019 Mar 12.

Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland; Neurology Clinic, Oulu University Hospital, Oulu, Finland; Medical Research Center (MRC), Oulu, Finland.

Objective: Epilepsy causes measurable irregularity over a range of brain signal frequencies, as well as autonomic nervous system functions that modulate heart and respiratory rate variability. Imaging dynamic neuronal signals utilizing simultaneously acquired ultra-fast 10 Hz magnetic resonance encephalography (MREG), direct current electroencephalography (DC-EEG), and near-infrared spectroscopy (NIRS) can provide a more comprehensive picture of human brain function. Spectral entropy (SE) is a nonlinear method to summarize signal power irregularity over measured frequencies. Read More

Wiad Lek 2019;72(2):165-168

Department of Neurology and Child Neurology, Kharkiv Medical Academy of Post-Graduate Education, Kharkiv, Ukraine.

Objective: Introduction: Epidemiological studies have shown that the risk of myocardial infarction and stroke is significantly higher in patients with epilepsy compared with people not suffering from epilepsy. The aim of the study was to study the parameters of HRV and EEG in patients with epilepsy to identify risk factors for cardiovascular pathology.

Patients And Methods: Materials and methods: We observed 50 patients with epilepsy without cardiovascular pathology (group 1) and 56 patients with epilepsy and cardiovascular pathology (group 2). Read More

Clin Auton Res 2019 04 22;29(2):131-133. Epub 2019 Mar 22.

Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.

Pediatr Int 2019 Mar 10;61(3):307-309. Epub 2019 Mar 10.

Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Hyogo, Japan.

Epilepsy Res 2019 07 20;153:76-78. Epub 2019 Feb 20.

Trafford Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RR, United Kingdom. Electronic address:

Pharmacological intervention is a mainstay for treatment of epilepsy. However, a third of patients with epilepsy remain drug resistant. Behavioural treatments such as biofeedback training can be potential effective alternative interventions for drug resistant epilepsy. Read More

Hum Brain Mapp 2019 06 28;40(9):2611-2622. Epub 2019 Feb 28.

NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France.

Despite numerous studies suggesting the role of insular cortex in the control of autonomic activity, the exact location of cardiac motor regions remains controversial. We provide here a functional mapping of autonomic cardiac responses to intracortical stimulations of the human insula. The cardiac effects of 100 insular electrical stimulations into 47 epileptic patients were divided into tachycardia, bradycardia, and no cardiac response according to the magnitude of RR interval (RRI) reactivity. Read More

Clin Auton Res 2019 04 25;29(2):137-150. Epub 2019 Feb 25.

Department of Neurology, General Hospital Hietzing-Neurological Center Rosenhügel, Riedelgasse 5, 1130, Vienna, Austria.

Purpose: To review the epidemiology and pathophysiology of autonomic symptoms and signs during epileptic seizures.

Methods: We performed a systematic literature search on the following autonomic symptoms and signs during epileptic seizures: cardiovascular changes, respiratory manifestations, gastrointestinal symptoms, cutaneous manifestations, sexual and genital manifestations, and urinary symptoms.

Results: Autonomic symptoms and signs can represent the predominant symptom at the onset of a focal seizure, which would then lead to the seizure being classified as a focal onset autonomic seizure. Read More