title: Physiologic autonomic arousal heralds motor manifestations of seizures in nocturnal frontal lobe epilepsy: implications for pathophysiology.
abstract: OBJECTIVE
  This study describes changes in heart rate (HR) and HR variability (HRV) related to clinical onset of seizures in nocturnal frontal lobe epilepsy (NFLE) in order to determine whether signs of autonomic activation precede onset of seizure motor manifestations, which was selected as seizure onset (SO). Further, to clarify the nature (epileptic or physiologic) of the changes in autonomic cardiac control presumed to precede SO, time-dependent variations in HR and HRV related to physiological cortical arousals associated with motor activity (phases of transitory activation, PAT) were also investigated.
  
  
  METHODS
  HR and HRV spectral power, quantified by means of wavelet transform, were analyzed in relation to the onset of motor manifestations in 45 NFLE seizures and 45 PAT derived from whole night video-polysomnographic recordings of ten patients and of ten control subjects, respectively.
  
  
  RESULTS
  Analysis of HRV showed a shift of sympathetic/parasympathetic cardiac control toward a sympathetic predominance in the 10s immediately preceding SO, while changes in HR were evident only one second before SO. This sympathetic activation was not associated with a sleep-wake transition or changes in respiratory activity, both of which occurred concurrently with SO. Similar changes in HR and HRV were observed in the 10s before the motor and electroencephalographic onset of PAT.
  
  
  CONCLUSIONS
  Our study demonstrates that a similar autonomic activation precedes the motor manifestations of NFLE seizures and physiological arousal. This autonomic activation could represent part of the arousal response, which could be implicated in the occurrence of both seizure and arousal motor manifestations.
authors.affiliation: IRCCS, Istituto delle Scienze Neurologiche, University of Bologna, Bologna, Italy. giovanna.calandra@unibo.it
authors.forename: Giovanna
authors.initials: G
authors.lastname: Calandra-Buonaura
authors.forename: Nicola
authors.initials: N
authors.lastname: Toschi
authors.forename: Federica
authors.initials: F
authors.lastname: Provini
authors.forename: Ivan
authors.initials: I
authors.lastname: Corazza
authors.forename: Francesca
authors.initials: F
authors.lastname: Bisulli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Barletta
authors.forename: Stefano
authors.initials: S
authors.lastname: Vandi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Montagna
authors.forename: Maria
authors.initials: M
authors.lastname: Guerrisi
authors.forename: Paolo
authors.initials: P
authors.lastname: Tinuper
authors.forename: Pietro
authors.initials: P
authors.lastname: Cortelli
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology*; D001341:Autonomic Nervous System / Q000502:physiology*; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology*; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology; D017286:Polysomnography; D012894:Sleep Stages / Q000502:physiology*; D055815:Young Adult