The Autonomic Function and Cerebral Autoregulation in Patients with Epilepsy

• Main Authors: Shu-Fang Chen, 陳淑芳
• Other Authors: Chuang YC
• Format: Others
• Language: en_US
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/78494008611146532993

博士 === 國立中山大學 === 生物科學系研究所 === 104 === Epilepsy leads patients to morbidity and mortality. The mechanisms of sudden unexplained death in epilepsy (SUDEP) are likely involved autonomic disturbance. The disturbance of autonomic nervous system (ANS) functions and the disorganization of cerebral autoregulation may contribute to the diseases’ prognosis of epilepsy. Better understanding of the ANS function and cerebral autoregulation in patients with epilepsy would help reduce the mortality and morbidity and to localize, manage the epilepsy. In this work, we evaluate serial ANS functions, cerebral autoregulation parameters, questionnaire, neurotrophic factors (brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1)) measurement in patients with inter-ictal epilepsy and the age- and sex-matched health volunteers to test these three hypothesis: (1) Disturbance in ANS functions, can occur in patients with epilepsy and different subtypes of epilepsy may contribute to different severity of ANS dysfunction (2) Changes in cerebral autoregulation can be involved in the inter-ictal epileptic patients (3) Neurotrophic factors play roles on ANS dysfunction in patients with epilepsy. 107 patients and 76 control subjects were investigated with a battery of ANS function tests: deep breathing, Valsalva maneuver (VM), Head-up Tilting (HUT), Q-sweat test and underwent the breath-holding test and tests for the cerebral autoregulation during VM and HUT using transcranial doppler (TCD). The autonomic severity score (adrenergic, cardiovagal, sudomtor and Modified Composite Autonomic Scoring Scale (mCASS)) and the cerebral autoregulation parameters (breath-hold index (BHI), autoregulation index calculated in phase II and IV during VM, cerebrovascular resistance (CVR), relatively cerebrovascular resistance (AC ratio) during HUT), questionnaire, BDNF and IGF-1 levels were assessed. In conclusion, patients with epilepsy inter-ictally have adrenergic, cardiovagal, sudomotor dysfunctions and impaired cerebral autoregulation compared to the controls. The temporal lobe epilepsy has more severe ANS profiles involvement and impairs cerebral autoregulation by reducing mean blood pressure. Reduced the cerebrovascular resistance at the 2nd minute of tilt-up was significant in patients with epilepsy, it may lead the cerebral blood flow velocity to drop in the following time of tilt-up and impair the cerebral autoregulation. The severity of ANS dysfunction correlated to the severity of cerebral vasomotor reactivity and cerebral autoregulation. The altered ANS functions interacted with disorganized cerebral autoregulation in patients with epilepsy. Both BDNF and IGF-1 play roles on ANS dysfunction prediction with different mechanisms in epilepsy. Keywords : epilepsy, SUDEP, autonomic nervous system, cerebral autoregulation, brain-derived neurotrophic factor (BDNF) , insulin-like growth factor-1 (IGF-1), autonomic questionnaire