Video EEG Monitorizasyon Ünitesinde Takip Edilen Epilepsi Hastalarının Retrospektif EKG Kayıtlarının Aritmi Açısından İncelenmesi

Year 2019, Volume: 45 Issue: 1, 55 - 58, 01.04.2019

Pınar Uzun Uslu , Aylin Bican Demir İbrahim Bora

https://doi.org/10.32708/uutfd.468093

Abstract

Video EEG monitorizasyon (VEM) ünitelerinde hastalara iki
elektrot aracığıyla eş zamanlı EKG monitörizasyonu yapılmaktadır. EKG kaydının
olması, EEG artefaktlarının epileptik deşarjlardan ayırımının yanı sıra,
interiktal ya da periiktal dönemde ortaya çıkabilicek kardiyak aritmileri de
gösterebilmektedir. Bu aritmilerin ayrıca ani beklenmeyen ölümlere (SUDEP:
Sudden unexpexcted death of epilepsy) yol açabileceği düşünülmektedir. Bu
çalışmada VEM ünitelerinde takip edilen hastaların eş zamanlı EEG-EKG kayıtları
retrospektif değerlendirilerek aritmilerin tanımlanması ve ilişkili olabilecek
faktörlerin belirlenmesi araştırılması amaçlandı. Mart 2014 ile Şubat 2016
arasında VEM ünitesinde takip edilen hastaların EEG-EKG kayıtları ve nöbet
semiyolojileri retrospektif olarak incelendi. Yaş, cinsiyet, nöbet
sınıflandırması, nöbet sayısı, aritmi varlığı, ortaya çıkış zamanı ve
tiplendirmesi yapılarak, bunların birbiri ile ilişkisi değerlendirildi.
Çalışmaya dahil edilen 165 hastanın %45,4 ‘ü (n:75) kadın, %54,5 ‘i (n:90)
erkekti. Kadın hastaların yaş ortalaması 34±3 iken erkeklarin yaş
ortalaması 49± 5 idi. Tüm bu hastaların EEG- EKG ve nöbet bulguları
değerlendirildi.  Hastaların %77’si (n:127)
fokal, %23’ü (n:38) jeneralize epilepsi hastasıydı. Kayıt edilen toplam 370
fokal nöbetin %62,9’u (n:233) temporal, %24,8’i 
(n:92) frontal, %9 (n:35) parietoksipital kaynaklıydı. Temporal lob
kaynaklı nöbetlerin %35’inde (n:82), frontal lob nöbetlerin %50’sinde (n:46)
parietoksipital  nöbetlerin %11’inde
(n:4) iktal taşikardi saptandı. Tespit edilen 79 jeneralize nöbetin %87’sinde
(n:69) iktal taşikardi tespit edildi. Temporal lob kaynaklı nöbetlerin
%5,6’sında (n: 13), frontal nöbetlerin %2,2’sinde (n:2) ve primer jeneralize
nöbetlerin ise %1’inde (n:8) iktal bradikardi saptandı.  Temporal epilepsili 1 (%0,43) hastada ise
iktal asistoli tespit edildi. Çalışmamızda epilepside ortaya çıkabilecek ritm
bozukluklarının sıklık, nöbet semiyolojisi ve EEG ile ilişkisinin belirlenmesi
amaçlanmıştır. 

Keywords

İktal EKG, iktal taşikardi, SUDEP, İktal bradikardi

Evaluation of the Simultaneous EEG-ECG Recordings of the Patients in Video EEG Monitorization Units in Regard to the Arrhythmias.

Abstract

Video
EEG monitoring (VEM) units are used for simultaneous ECG monitoring with two
electrodes. The presence of ECG recordings may also indicate cardiac
arrhythmias, which may ocur in the interictal or periictal period, as well as
the differentiation of EEG artifacts from epileptic discharges. These
arrhythmias are also thought to lead to sudden unexpected deaths (SUDEP: sudden
epilepsy death). The aim of this study was to evaluate the simultaneous EEG-ECG
recordings of the patients who were followed in VEM units and to determine the
factors that may be related to the identification of the arrhythmias. EEG-ECG
recordings and seizure semiology of the patients who were followed in VEM unit
between March 2014 and February 2016 were retrospectively analyzed.  Age, gender, seizure classification, seizure
number, presence of arrhythmia, type of arrhythmia and their relation with each
other were evaluated. Of the 165 patients included in the study, 45.4% (n: 75)
were female and 54.5% (n: 90) were male. The mean age of the females was 34 ± 3
years and the mean age of the males was 49 ± 5 years. EEG-ECG and seizure
findings of all these patients were evaluated. 77% (n: 127) of the patients  were focal and 23% (n: 38) were generalized
epilepsy patients. Of the total recorded 370 focal seizures, 62,9% (n:233) were
temporal, 24,8% (n:92) were frontal, 9% (n:35) were from parieto occipital
origin. Ictal tachycardia was found in 35% (n:82) of the temporal lobe-induced
seizures, 50% (n:46) of the frontal lobe seizures and 11% (n:4) of the
parieto-occipital seizures. Ictal tachycardia was detected in 87% (n:69) of 79
generalized seizures. In 5.6% (n:13) of the temporal lobe-induced seizures ,
2.2% (n: 2) of frontal seizures and 1% (n: 8) of primary generalized seizures
were ictal bradycardia. In patients with temporal epilepsy was detected ictal
asystole 0.43% (n:1).The aim of this study was to determine frequency of rhythm
disorders  that may occur in epilepsy,
the relationship between seizure semiology and EEG.

Keywords

ictal ECG, ictal tachycardia, SUDEP, ictal bradycardia

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