Distinction between epileptic and non-epileptic arousal by heart rate change

• Published in: Epilepsy & behavior 2023-11, Vol.148, p.109487-109487, Article 109487
• Main Authors: Kubota, Takafumi, Thyagaraj, Suraj, Gia Huynh, Huan, Kanubhai Gajera, Prasannakumar, Awori, Violet, Zande, Jonathan L., Lüders, Hans O., Fernandez-Baca Vaca, Guadalupe
• Format: Article
• Language: English
• Subjects: arousal; heart rate; ictal tachycardia; nocturnal seizure; sudden unexpected death in epilepsy
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2023.109487

•We investigated heart rate (HR) between epileptic and non-epileptic arousals.•Within 60 seconds after arousal, HR increased by 86.7% in the epileptic arousals.•Within 60 seconds after arousal, HR increased by 26.1% in the non-epileptic arousals.•The cutoff value was 48.7%, sensitivity 0.79, and specificity 0.80.•More than 70.1% was only in the epileptic arousals, with 100% specificity. We investigated the difference in heart rate (HR) change between epileptic and non-epileptic arousals in adult patients with epilepsy (PWE). This is a case-control study conducted at the University Hospitals of Cleveland Medical Center. Inclusion criteria are (1) adult (≥18 years old) PWE who had arousal related to a focal aware or impaired awareness automatism seizure during an Epilepsy Monitoring Unit (EMU) admission between January 2009 and January 2021 or (2) adult PWE who had a non-epileptic arousal during an EMU admission between July 2020 and January 2021. Outcomes are: (1) a percent change in baseline HR within 60 seconds after arousal and (2) the highest percent change in baseline HR within a ten-second sliding time window within 60 seconds after arousal. We included 20 non-epileptic arousals from 20 adult PWE and 29 epileptic arousals with seizures from 29 adult PWE. Within 60 seconds after arousal, HR increased by a median of 86.7% (IQR, 52.7–121.3%) in the epileptic arousal group compared to a median of 26.1% (12.9–43.3%) in the non-epileptic arousal group (p < 0.001). The cut-off value was 48.7%. The area under the curve (AUC), sensitivity, and specificity were 0.85, 0.79, and 0.80, respectively. More than 70.1% was only in the epileptic arousals, with 100% specificity. Within 10 seconds of the greatest change, HR increased by 36.5 (18.7– 48.4) % in the epileptic arousal group compared to 17.7 (10.9-23.7) % in the non-epileptic arousal group (p < 0.001). The cut-off value was 36.5%. The AUC, sensitivity, and specificity were 0.79, 0.52, and 0.95, respectively. More than 48.1% was only in the epileptic arousals, with 100% specificity. Tachycardia during epileptic arousals was significantly higher and more robust compared to tachycardia during non-epileptic arousals.