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Dysautonomia in people with epilepsy: A scoping review

Published:December 15, 2022DOI:https://doi.org/10.1016/j.seizure.2022.12.003

      Highlights

      • Heart rate variability is a common method used by the neurologist to measure dysautonomia.
      • There are not clear parameters for dysautonomia measurements in people with epilepsy.
      • Dysautonomia may have a relationship with sudden unexpected death in patients with epilepsy.

      Abstract

      Background

      Epilepsy is one of the most common neurological diseases and has high morbidity and mortality. Multiple methods for assessing dysautonomia have been reported; however, the patient characteristics and epilepsy features that drive any method selection are unclear. People with epilepsy (PWE) can experience sudden unexpected death in epilepsy (SUDEP) and one reason can be dysautonomia. If dysautonomia can be detected in PWE before a severe event, then it could complement and redirect patient treatment and monitoring.

      Objective

      To map the available literature on dysautonomia in PWE and describe patients’ characteristics and methods used to evaluate dysautonomia.

      Methods

      We performed a scoping literature review. We searched PubMed, Scopus, Embase, and hand searched starting from the first registry in the literature until August 2019. Studies were independently assessed by three authors and two epileptologists. We present data in tables and summarize information according to the following structure: population, concepts, and context.

      Results

      Thirty-five studies were included in the analysis with epidemiological designs including case reports (23), cross-sectional studies (4), case‒controls (7), and cohort studies (1). A total of 618 patients were enrolled. Heart rate variability, arrhythmia, blood pressure, the tilt-table test, polysomnography, respiratory function, and magnetic resonance imaging were the methods most commonly used to assess dysautonomia in PWE. A detailed description of the heart rate variability assessment is presented.

      Conclusions

      This review provides a broad description of the available literature identifying clinical findings, the most frequently reported assessment measurements of dysautonomia, in temporal lobe epilepsy and extratemporal epilepsies.

      Keywords

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