Pınar UZUN USLU, Aylin BİCAN DEMİR, İbrahim BORA

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

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.

Anahtar Kelimeler:

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.

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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