Abstracts

Exploring Autonomic Responses in Epilepsy: Insights from Cortical Stimulation

Abstract number : 2.342
Submission category : 6. Cormorbidity (Somatic and Psychiatric)
Year : 2024
Submission ID : 216
Source : www.aesnet.org
Presentation date : 12/8/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Hellen Kreinter, MD – Western University

Leena Shoemaker, PhD – Western University
Jorge Burneo, MD, MSPH, FAAN, FAES, FRCPC – Western University, London Ontario Canada
Giovanni Pellegrino, MD, PhD – Western University
David Steven, MD, MPH, FRCSC, FACS – Western University
Jonathan Lau, MD, PhD, FRCSC – Western University, London Ontario Canada
Keith MacDougall, MD – Western University
Michelle-Lee Jones, MD, FRCPC – Western University, London Ontario Canada
David Diosy, MD – Western University
J. Kevin Shoemaker, PhD – Western University
Ana Suller-Marti, MD, PhD – Schulich School of Medicine and Dentistry Western University London Health Sciences Center

Rationale: The leading cause of death in patients with drug-resistant epilepsy is attributed to sudden unexpected death in epilepsy (SUDEP). The mechanisms for SUDEP are still unclear; however, three main hypotheses include respiratory dysfunction, cardiac arrhythmias, and alterations in cerebral blood flow autoregulation. Cortical stimulation (CS) has been used to analyze different physiological-hemodynamic and pathological responses after stimulating specific brain structures in patients with epilepsy. This abstract summarizes the hemodynamic outcomes of seizures induced by electrical stimulation of regions within the central autonomic network (CAN), which could expand knowledge of the autonomic system in patients with epilepsy and its potential implications for SUDEP.




Methods: In this prospective study, we are recording, collecting, and analyzing electrophysiological parameters, including heart rate, blood pressure, respiration, and intracranial recordings during the clinical CS study in patients implanted with depth electrodes.


Results: Seventeen patients who underwent CS with simultaneous recording of hemodynamic variables were included. The preliminary analysis of five of these patients showed the following information. Case 1: A clinical seizure was triggered after stimulating the right anterior hippocampus (RAHc) with 2 mA. Hemodynamically, the response was tachycardia and hypertension. Epileptogenic zone (EZ) post-SEEG: multifocal (bitemporal and right lingula). Case 2: A clinical seizure was triggered after stimulating the left posterior insula at 4mA. Hemodynamically, the response was tachycardia. EZ post-SEEG: left posterior temporal. Case 3: A clinical seizure was triggered after stimulating the RAHc at 2mA. The hemodynamic response was hypertension and tachycardia. EZ post-SEEG: Right opercular-insular region. Case 4: A clinical seizure was triggered after stimulating the LAHc at 6 mA. The hemodynamic response was hypotension and tachycardia. EZ post-SEEG: Right mesial temporal. Case 5: A clinical seizure was triggered after stimulating the left amygdala at 7 mA. The hemodynamic response was hypertension and tachycardia. EZ post-SEEG: Bilateral mesial temporal.

Conclusions: Seizures triggered during the CS on structures associated with the CAN may produce autonomic responses; the most common ones seen in our patients are hypertension and tachycardia. The results may be influenced by other factors, including medications and comorbidities. More data is needed to establish associations and understand the possible relations with SUDEP.

Funding: No financial support was received for this study.


Cormorbidity (Somatic and Psychiatric)