Νευροφυσιολογική μελέτη διαταραχών του αυτόνομου νευρικού συστήματος σε ασθενείς με επιληψία και η σχέση αυτών με τον τύπο της επιληψίας και την αντιεπιληπτική αγωγή

Abstract

Our purpose was to assess the function of fast somatic nerve fibres, the sympathetic sudomotor system and the function of parasympathetic heart control in patients with partial or generalized seizures, receiving various therapeutic regimes, by means of clinical routine neurophysiology. We studied 73 patients (mean age 37,7±12,9 years) and 73 matched healthy controls by clinical and electrophysiological examinations. To assess the function of fast somatic nerve fibres we studied the motor conduction of the peroneal nerve (distal latency, amplitude of action potential, conduction velocity) and the sensory conduction of the ulnar and sural nerves (amplitude of action potential, conduction velocity) in all patients and controls. To assess the sympathetic sudomotor system we studied the sympathetic skin response (SSR) elicited in the hand and foot by electrical and magnetic stimulation. The electrical stimulation applied in all patients and controls but the magnetic stimulation applied in 61 patients and 72 controls (excepted patients and controls which had something metallic in their body such as surgical clips, pace-maker, metallic valve). To assess the function of parasympathetic heart control all the patients and the controls were subjected to a battery of three cardiovascular tests: a) heart rate variability during six deep breaths/min [algorithm:(max-min)R-R Interval x 100/mean R-R Interval] b) Valsava maneuver (ratio of the shortest RR interval during phase II to the longest RR interval in phase IV) c) heart rate response to standing up (ratio 30th beat/15th beat). Compared to controls, patients showed a significant abnormality of motor (prolongation of distal latency) and sensory (slowing of ulnar conduction velocity, reduction of amplitude of sural action potential) conduction. Reason and duration of epilepsy, type and frequency of seizure and polytherapy didn’t appear to have a negative effect on motor or sensory conduction. Particular antiepileptic drugs, oxcarbazepine, phenytoin, topiramate, lebetiracetam, appeared to have a negative effect on sensory conduction. Clinical sings of neuropathy were disclosed in 13,7% of patients, while at least one abnormal sensory parameter was evident in 11%. In the patient group as opposed to the control group, there was a latency prolongation of sympathetic skin response recorded in hand and foot to electrical and magnetic stimulation. At least one SSR abnormality was shown in 28 (38,3%) patients and 9 (12,3%) of these had absent SSR from the hand or/and the food with electrical or/and magnetic stimulation. Reason & duration of epilepsy, type, frequency & age at onset of seizure, time from last seizure and polytherapy didn’t appear to have a negative effect on sympathetic sudomotor function. Particular antiepileptic drugs, topiramate and phenytoin, appeared to have a negative effect on sympathetic sudomotor function. Finally, the patient group showed significantly difference in all parasympathetic parameters studied compared to controls. Overall, 42,2% of patients had abnormal measurement in at least one of these parameters and [algorithm:(max-min)R-R Interval x 100/mean R-R Interval] was the most frequently abnormal one (31,5% of patients). Reason & duration of epilepsy, frequency, type & age at onset of seizure, time from last seizure and polytherapy didn’t appear to have a negative effect. Particular antiepileptic drugs, oxcarbazepine and phenytoin appeared to have a negative effect on function of para-sympathetic heart control. Overall, 50 of the 73 patients had abnormal measurement in at least one of all parameters which we studied. Our results suggested that simple neurophysiological tests, suitable for screening purposes, were able to demonstrate abnormalities of the fast somatic fibers in peripheral nerves, of the sympathetic sudomotor system and of the parasympathetic heart control.

Σκοπός της μελέτης μας ήταν να εκτιμήσουμε τη λειτουργία των σωματικών νεύρων, τη δράση του συμπαθητικού στη λειτουργία της εφίδρωσης καθώς και τη δράση του παρασυμπαθητικού στο καρδιαγγειακό σύστημα, σε ασθενείς με εστιακές ή γενικευμένες επιληπτικές κρίσεις οι οποίοι λαμβάνουν αντιεπιληπτική αγωγή είτε με τη μορφή της μονοθεραπείας είτε με τη μορφή συνδυασμού φαρμάκων. […]