Effects of anterior thalamic nucleus DBS on interictal heart rate variability in patients with refractory epilepsy

Katalin Lőrincz; Beáta Bóné; Kázmér Karádi; Greta Kis-Jakab; Natália Tóth; László Halász; Loránd Erőss; István Balás; Béla Faludi; Zsófia Jordán; Zoltan Chadaide; Csilla Gyimesi; Dániel Fabó; József Janszky

doi:10.1016/j.clinph.2022.11.020

Effects of anterior thalamic nucleus DBS on interictal heart rate variability in patients with refractory epilepsy

Clin Neurophysiol. 2023 Mar:147:17-30. doi: 10.1016/j.clinph.2022.11.020. Epub 2022 Dec 15.

Authors

Affiliations

¹ Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler str. 3, 72076 Tübingen, Germany. Electronic address: lorinczkati@gmail.com.
² Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary.
³ Department of Behavioral Sciences, Medical School, University of Pecs, Szigeti u.12, H-7624 Pecs, Hungary.
⁴ Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Ret u. 2., H-7623 Pecs, Hungary.
⁵ Department of Functional Neurosurgery, National Institute of Neurosciences, Amerikai ut 57, H-1345 Budapest, Hungary.
⁶ Department of Neurosurgery, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary.
⁷ Department of Neurology, National Institute of Neurosciences, Amerikai ut 57., H-1345 Budapest, Hungary.
⁸ University of Szeged Albert Szentgyörgyi Medical School, Tisza Lajos krt.109, 6725 Szeged, Hungary.

PMID: 36630886
DOI: 10.1016/j.clinph.2022.11.020

Abstract

Objective: Heart rate variability (HRV) changes were investigated by several studies after resective epilepsy surgery/vagus nerve stimulation. We examined anterior thalamic nucleus (ANT)-deep brain stimulation (DBS) effects on HRV parameters.

Methods: We retrospectively analyzed 30 drug-resistant epilepsy patients' medical record data and collected electrocardiographic epochs recorded during video- electroencephalography monitoring sessions while awake and during N1- or N2-stage sleep pre-DBS implantation surgery, post-surgery but pre-stimulation, and after stimulation began.

Results: The mean square root of the mean squared differences between successive RR intervals and RR interval standard deviation values differed significantly (p < 0.05) among time-points, showing increased HRV post-surgery. High (0.15-0.4 Hz) and very low frequency (<0.04 Hz) increased, while low frequency (0.04-0.15 Hz) and the LF/HF ratio while awake decreased, suggesting improved autonomic regulation post-surgery. Change of effect size was larger in patients where both activated contacts were located in the ANT than in those where only one or none of the contacts hit the ANT.

Conclusions: In patients with drug-resistant epilepsy, ANT-DBS might positively influence autonomic regulation, as reflected by increased HRV.

Significance: To gain a more comprehensive outcome estimation after DBS implantation, we suggest including HRV measures with seizure count in the post-surgery follow-up protocol.

Keywords: Deep brain stimulation; Drug-resistant; Epilepsy; Heart rate variability; Thalamus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anterior Thalamic Nuclei*
Arrhythmias, Cardiac
Deep Brain Stimulation* / methods
Drug Resistant Epilepsy*
Epilepsy* / therapy
Heart Rate / physiology
Humans
Retrospective Studies