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. 2024 Jun 5;6(1):e000665.
doi: 10.1136/bmjno-2024-000665. eCollection 2024.

Heartbeat evoked potentials and autonomic arousal during dissociative seizures: insights from electrophysiology and neuroimaging

Vera Flasbeck #  1 , Johannes Jungilligens #  2 , Isabell Lemke  2 , Jule Beckers  2 , Hilal Öztürk  2   3 , Jörg Wellmer  4 , Corinna Seliger  2 , Georg Juckel  1 , Stoyan Popkirov  5
Affiliations

Heartbeat evoked potentials and autonomic arousal during dissociative seizures: insights from electrophysiology and neuroimaging

Vera Flasbeck et al. BMJ Neurol Open. .

Abstract

Introduction: Dissociative seizures often occur in the context of dysregulated affective arousal and entail dissociative symptoms such as a disintegration of bodily awareness. However, the interplay between affective arousal and changes in interoceptive processing at the onset of dissociative seizures is not well understood.

Methods: Using retrospective routine data obtained from video-electroencephalography telemetry in a university hospital epilepsy monitoring unit, we investigate ictal changes in cardiac indices of autonomic arousal and heartbeat evoked potentials (HEPs) in 24 patients with dissociative seizures.

Results: Results show autonomic arousal during seizures with increased heart rate and a shift towards sympathetic activity. Compared with baseline, ictal HEP amplitudes over central and right prefrontal electrodes (F8, Fz) were significantly less pronounced during seizures, suggesting diminished cortical representation of interoceptive information. Significant correlations between heart rate variability measures and HEPs were observed at baseline, with more sympathetic and less parasympathetic activity related to less pronounced HEPs. Interestingly, these relationships weakened during seizures, suggesting a disintegration of autonomic arousal and interoceptive processing during dissociative seizures. In a subgroup of 16 patients, MRI-based cortical thickness analysis found a correlation with HEP amplitudes in the left somatosensory association cortex.

Conclusions: These findings possibly represent an electrophysiological hint of how autonomic arousal could negatively impact bodily awareness in dissociative seizures, and how these processes might be related to underlying brain structure.

Keywords: EEG; EVOKED POTENTIALS, SOMATOSENSORY; FUNCTIONAL NEUROLOGICAL DISORDER; MRI; STRESS.

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Conflict of interest statement

Competing interests: SP receives royalties from Springer for a book on functional neurological disorders and has received speaking fees from Novartis and Esai. JW has received speaker fees from UCB, Eisai, Bial, GW pharmaceuticals, and Desitin. The other authors report there are no competing interests to declare.

Figures

Figure 1
Figure 1
Flow chart depicting the search and selection process as well as the data analysis plan. vEEG, video-electroencephalography.
Figure 2
Figure 2
Comparisons of heartbeat-evoked potential (HEP) waveforms (upper row) during baseline (black) and seizure (red) for F7 (left), Fz (middle) and F8 (right) electrodes. Mean HEP amplitudes and SEM (SE of the mean) are shown in bar diagrams in the lower row. *p<0.05.
Figure 3
Figure 3
Exemplary illustration of the correlation between heart rate variability (RMSSD, root mean square of the successive differences; a measure of short-term variability in heart rate reflecting parasympathetic activity) and heartbeat-evoked potentials (F8) at baseline (left) and during seizures (right). During seizures, correlations were weakened and lost statistical significance. HEP, heartbeat-evoked potential.
Figure 4
Figure 4
Correlation of cortical thickness with early central (Fz) heartbeat-evoked potential amplitude, corrected for age, sex, scanner type and total intracranial volume. A, anterior; P, posterior.
See this image and copyright information in PMC

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