title: Earlier tachycardia onset in right than left mesial temporal lobe seizures.
abstract: OBJECTIVE
  To clarify whether the presence and timing of peri-ictal heart rate (HR) change is a seizure lateralizing sign in patients with mesial temporal lobe epilepsy (mTLE).
  
  
  METHODS
  Long-term video EEGs were retrospectively reviewed in 21 patients, 7 men and 14 women aged 13 to 67 years, diagnosed as mTLE with MRI lesions in the mesial temporal structures (hippocampal sclerosis in 20 cases, amygdala hypertrophy in 1 case). Seventy-seven partial seizures without secondary generalization were extracted. Peri-ictal HR change was compared between 29 right seizures (9 patients) and 48 left seizures (12 patients).
  
  
  RESULTS
  HR abruptly increased in all 29 right seizures and 42 of 48 left seizures. Onset time of HR increase in relation to ictal EEG onset was significantly earlier in right seizures than in left seizures (mean ± SD, -11.5 ± 14.8 vs 9.2 ± 21.7 seconds; p < 0.0001). Time of maximum HR was also significantly earlier in right seizures than in left seizures (36.0 ± 18.1 vs 58.0 ± 28.7 seconds; p < 0.0001). Maximum HR changes from baseline showed no significant difference between right and left seizures (47.5 ± 19.1 vs 40.8 ± 20.0/min).
  
  
  CONCLUSIONS
  Significantly earlier tachycardia in right than left mTLE seizures supports previous hypotheses that the right cerebral hemisphere is dominant in the sympathetic network. No HR change, or delayed tachycardia possibly due to seizure propagation to the right hemisphere, may be a useful lateralizing sign of left mTLE seizures.
authors.affiliation: From the Departments of Epileptology (K.K., K.J., H.I., Y.K., N.N.), Neurosurgery (M.I.), and Neurology (K.K., M.A.), Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kato
authors.affiliation: From the Departments of Epileptology (K.K., K.J., H.I., Y.K., N.N.), Neurosurgery (M.I.), and Neurology (K.K., M.A.), Tohoku University Graduate School of Medicine, Sendai, Japan. jink@med.tohoku.ac.jp.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Jin
authors.affiliation: From the Departments of Epileptology (K.K., K.J., H.I., Y.K., N.N.), Neurosurgery (M.I.), and Neurology (K.K., M.A.), Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Itabashi
authors.affiliation: From the Departments of Epileptology (K.K., K.J., H.I., Y.K., N.N.), Neurosurgery (M.I.), and Neurology (K.K., M.A.), Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: From the Departments of Epileptology (K.K., K.J., H.I., Y.K., N.N.), Neurosurgery (M.I.), and Neurology (K.K., M.A.), Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kakisaka
authors.affiliation: From the Departments of Epileptology (K.K., K.J., H.I., Y.K., N.N.), Neurosurgery (M.I.), and Neurology (K.K., M.A.), Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Aoki
authors.affiliation: From the Departments of Epileptology (K.K., K.J., H.I., Y.K., N.N.), Neurosurgery (M.I.), and Neurology (K.K., M.A.), Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Nakasato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004292:Dominance, Cerebral / Q000502:physiology*; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013610:Tachycardia / Q000150:complications / Q000503:physiopathology*; D013997:Time Factors; D055815:Young Adult