| Summary: | 碩士 === 高雄醫學大學 === 醫學研究所碩士班 === 104 === SUDEP is an important cause of death in the patients with epilepsy. The clear mechanism of sudden death is not clear. In the previous study, we found there were associated factors of SUDEP including history of general tonic-clonic seizure, the frequency of seizure in the recent 3 months, the use of Carbamazepine and Lamotrigine, and nocturnal seizure.
In previous study, we investigated sudden death with HRV (heart rate variability) in patients with heart disease. HRV is a reliable reflection of the many physiological factors modulating the normal rhythm of the heart including sympathetic and parasympathetic function. We hypothesized that SUDEP is related to autonomic change in the patients with epilepsy. We plan to investigate the risk factos of SUDEP with HRV and and try to reveal if there is association of autonomic change with them.
We do a retrospective study and collect the epilepsy patients followed in our out patient department. We excluded patients with diabetes mellitus, renal failure, alcoholism, cardiac arrthymia, hyperthyroidism, parkinsonism, patients with malignancy, the use of beta blocker and calcium channel blocker, because they may influence the result the heart rate variability. We included the epilepsy patients with monotherapy to eliminate confounding effect of different antiepileptic agents in the same patient. The antiepileptic agents should be in stable dose in the patient for over one month. We collected their EKG recording in their EEG study. The well-qualified and 5 minutes segmented EKG recording was analyzed with the parameters of heart rate variability.
In the results of HRV, the parameters declined with age, and the patients with the general tonic clonic seizure. There was a trend in the female with lower HRV. There was no stastic association with HRV and different antiepileptic agents, and either in the patient with recent seizure in one month. We did multiple linear regression to analyze the confounding effect. The result revealed that the HRV declined with old age, female and patients with general tonic clonic seizure.
In our study, we have the clonclusion that the heart rate variability was decreased in old age, female gender and patients with general tonic clonic seizure. This may predicte a declined autonomic function and may be related to increasing risk of sudden death. We cannot find the association of HRV change with different antiepileptic medication. So the increased risk of sudden death in Carbamazepine and Lamotrigine mayresult from other mechanism but rather than autonomic change. The limitation of our study is case number. We expect that we can include more patients to clearify the the impact of the seizure type on the autonomic function.
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