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. 2020 Nov:112:107353.
doi: 10.1016/j.yebeh.2020.107353. Epub 2020 Aug 27.

Can seizure-related heart rate differentiate epileptic from psychogenic nonepileptic seizures?

Hue Mun Au Yong  1 , Erica Minato  2 , Eldho Paul  3 , Udaya Seneviratne  4
Affiliations

Can seizure-related heart rate differentiate epileptic from psychogenic nonepileptic seizures?

Hue Mun Au Yong et al. Epilepsy Behav. 2020 Nov.

Abstract

Objectives: We aimed to (1) determine if seizure-related heart rate (HR) differentiates epileptic seizures (ES) from psychogenic nonepileptic seizures (PNES); (2) define the most useful point of the following HR measurements: preictal, ictal-onset, maximal-ictal, or postictal; and (3) delineate the optimal HR cutoff points (absolute HR and relative HR increase) to differentiate ES from PNES.

Methods: All video-electroencephalography (VEEG) recorded at an Australian tertiary hospital from May 2009 to November 2015 were retrospectively reviewed. Baseline (during rest and wakefulness), 1-min preictal, ictal-onset, maximal-ictal, and 1-min postictal HR were measured for each ES and PNES event. Events lasting <10 s or with uninterpretable electrocardiogram (ECG) due to artifacts were excluded. Receiver operating characteristic curve analysis was performed to assess the diagnostic accuracy of HR reflected by the area under the curve (AUC).

Results: Video-electroencephalography of 341 ES and 265 PNES from 130 patients were analyzed. The AUC for preictal, ictal-onset, maximal-ictal, and postictal HR were found to have poor differentiation between all types of ES and PNES. However, comparing bilateral tonic-clonic ES and PNES, AUC for absolute maximal-ictal HR was 0.84 (95% confidence interval [CI]: 0.73-0.95) and for absolute postictal HR was 0.90 (95% CI: 0.81-1.00) indicating good diagnostic discrimination. Using Youden's index to diagnose tonic-clonic ES, the optimal cutoff point for absolute maximal-ictal HR was 114 bpm (sensitivity: 84%, specificity: 82%) and for absolute postictal HR was 90 bpm (sensitivity: 91%, specificity: 82%).

Conclusion: These findings suggest that seizure-related HR is useful in differentiating bilateral tonic-clonic ES from PNES. Based on the AUC, the best diagnostic measurements are maximal-ictal and postictal HR.

Keywords: Diagnostic accuracy; Epilepsy; Epilepsy monitoring; Nonepileptic seizures; Receiver operating characteristic curve; Seizure semiology.

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Conflict of interest statement

Declaration of competing interest U. Seneviratne has received travel and speaker honoraria from Eisai Australia and LivaNova Australia. H.M. Au Yong, E. Minato, and E. Paul have no conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.