Herzratenveränderung als diagnostischer Indikator zur Unterscheidung von epileptischen und psychogenen Anfällen
Loading...
Files
Date
2025-10-21
Authors
Publisher
Philipps-Universität Marburg
item.page.supervisor-of-thesis
Abstract
Background
Epilepsy is one of the most common chronic neurological diseases, in which generalized
tonic-clonic seizures (GTCS) must be differentiated from complex focal seizures (CFS).
However, psychogenic nonepileptic seizures (PNES) must be distinguished from real epileptic seizure (ES) types. A clear differentiation is complicated by the fact that epilepsy is
often misdiagnosed and treated as such due to similar clinical manifestations.
Objectives
The aim was to (1) determine if seizure-related heart rate (HR) change differentiates epileptic seizures (ES) from psychogenic nonepileptic seizures (PNES); (2) define the most
useful point of the following HR measurements: preictal, ictal-onset, maximal-ictal, or postictal; and (3) subsequently identify the optimal quotient of baseline and measurement point
HR for differentiation of PNES and ES, which demonstrates the highest degree of sensitivity and specificity.
Methods
At the Epilepsy Center Hessen in Marburg, all patients between 2007 and 2015 were retrospectively screened from video EEG monitoring (VEM). A matched group of 24 ES and 24
PNES (the latter with two seizures) according to comparable age and sex was selected
(PNES: 31,5 ES: 31 y/o | F/M PNES and ES: 18/6). HR change in PNES was measured at a
total of 24 time points: 2 baseline (during sleep and wakefulness), 4 preictal, 10 ictal, 8
postictal. HR measurement in GTKA/KFA was performed at 20 time points: 2 baseline
(during sleep and wakefulness), 4 preictal, 6 ictal, 8 postictal. Recording interruptions of
< 10 sec and ECGs that could not be interpreted due to artifacts had been eliminated.
Results
The change and absolute frequency for preictal, ictal-onset and maximal-ictal HR were
found to have poor differentiation between all types of ES and PNES.
Although HR increased slightly in PNES preictally compared with GTCS/CFS, GTCS/CFS
onset reached comparable values. Ictally, the heart rate also did not differ significantly in
its level. The lower number of measurement points in GTCS/CFS was due to the shorter
seizure duration compared with PNES. However, significant differences were found postictally. In contrast to ES, heart rate in PNES dropped immediately postictally and was approximately 10 bpm above baseline during wakefulness. In ES, the heart rate increased postictally and was 48 bpm above baseline. In PNES, the heart rate flattened continuously postictally, whereas in ES it remained high and was still 40 bpm above baseline postictally for
15 minutes.
Three measurement time points emerged for optimal differentiation of PNES and
GTCS/CFS:
(1) one minute after seizure termination with a quotient of 1.25 (< 25 percent
exceedance baseline) at a sensitivity/specificity of 79.1 and 87.5 percent respectively;
(2) 10 minutes after seizure termination with the same values at a quotient
(threshold) of < 1.2;
(3) 15 minutes postepisodal/ictal at a quotient < 1.2 with a sensitivity/specificity of 79.1 percent/ 91.6 percent. At this point, the ppW as well as the npW
also reached the maximum with 90.4 and 81.4 percent respectively.
Conclusion
The results confirm that the seizure-related HR change is fundamentally suitable as a measure of differentiation between GTCS/CFS and PNES. In this regard, the three identified
measurement points are also particularly distinctive from a diagnostic perspective (bedside
test), with the optimal postepisodal/-ictal time point being 15 min with a threshold of 1.2.
Due to the numerically limited study population, the results have to be seen carefully and
larger studies are warranted.
Review
Metadata
Contributors
Supervisor:
Dates
Created: 2025Issued: 2025-10-21Updated: 2025-10-21
Faculty
Medizin
Language
ger
Data types
DoctoralThesis
Keywords
EpilepsyGTKheart ratepsychogenicheart rate change
DFG-subjects
EpilepsieBTKAdissoziativ,psychogenHerzrateKFAHerzratenveränderungPNESGTKA
DDC-Numbers
610
show more
Waschik, Paolo Michele: Herzratenveränderung als diagnostischer Indikator zur Unterscheidung von epileptischen und psychogenen Anfällen. : Philipps-Universität Marburg 2025-10-21. DOI: https://doi.org/10.17192/z2025.0440.
License
This item has been published with the following license: In Copyright