title: Pre- and postictal, not ictal, heart rate distinguishes complex partial and psychogenic nonepileptic seizures.
abstract: Psychogenic nonepileptic seizures (PNES) remain poorly understood neurobiologically. Previously reported work suggests that adjunct ictal heart rates (HRs) may differentiate PNES from complex partial seizures (CPS). We retrospectively reviewed and compared preictal, ictal, and postictal HR differences in patients with PNES (n=42) and CPS controls (n=46) electively admitted for video/EEG monitoring to further characterize PNES autonomic patterns. Statistically significant preictal HR increases (P=0.006) and postictal (P=0.015) HR reductions normalized to baseline were identified in subjects with PNES compared with CPS controls. Ictal HRs were not found to differentiate between PNES and CPS events. This pattern of pre-event HR increases and postevent HR decreases in patients with PNES compared with those with CPS suggests frontolimbic neural circuit dysfunction and merits further exploration.
authors.affiliation: Edward B. Bromfield Epilepsy Program, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA. CReinsberger@partners.org
authors.forename: Claus
authors.initials: C
authors.lastname: Reinsberger
authors.forename: David L
authors.initials: DL
authors.lastname: Perez
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Murphy
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Dworetzky
mesh_terms: D003291:Conversion Disorder / Q000523:psychology*; D004562:Electrocardiography; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000503:physiopathology* / Q000523:psychology*; D014741:Video Recording