Comparing maximum autonomic activity of psychogenic non-epileptic seizures and epileptic seizures using heart rate variability

• Heart rate variability reveals changes in autonomic nerves system (ANS) during seizure.
• Comparison of ANS response in psychogenic non-epileptic seizures (PNES) and epileptic seizures.
• Epileptic seizures show higher maximum sympathetic tonus than PNES.
• No minimum parasympathetic difference was found between epileptic seizures and PNES.
• Distinguishing epileptic seizures and PNES solely with HRV measures seems difficult.

PurposeThe semiology of psychogenic non-epileptic seizures (PNES) can resemble epileptic seizures, and differentiation between epileptic seizures with no EEG-correlate and PNES can be challenging even for trained experts. Therefore, there has been a search for a quantitative measure, other than EEG and semiology that could distinguish PNES from epileptic seizures. We used ECG to measure heart rate variability (HRV) in order to compare maximum autonomic activity of epileptic seizures and PNES. These comparisons could potentially serve as biomarkers for distinguishing these types of clinical episodes.MethodForty-nine epileptic seizures from 17 patients and 24 PNES from 7 patients with analyzable ECG were recorded during long-term video-EEG monitoring. Moving windows of 100 R–R intervals throughout each seizure were used to find maximum values of Cardiac Sympathetic Index (CSI) (sympathetic tonus) and minimum values of Cardiac Vagal Index (CVI), Root-Mean-Square-of-Successive-Differences (RMSSD) and HF-power (parasympathetic tonus). In addition, non-seizure recordings of each patient were used to compare HRV-parameters between the groups.ResultsThe maximum CSI for epilepsy seizures were higher than PNES (P = 0.015). The minimum CVI, minimum RMSSD and HF-power did not show significant difference between epileptic seizures and PNES (P = 0.762; P = 0.152; P = 0.818). There were no statistical difference of non-seizure HRV-parameters between the PNES and epilepsy patients.ConclusionWe found the maximum sympathetic activity accompanying the epileptic seizures to be higher, than that during the PNES. However, the great variation of autonomic response within both groups makes it difficult to use these HRV-measures as a sole measurement in distinguishing epileptic seizures from PNES.