Method for recording cardiovascular and respiratory disorders in patients with focal drug-resistant epilepsy during stereoelectroencephalographic monitoring using electrical stimulation of brain structures
The method of direct electrical stimulation with depth electrodes and stereo-EEG monitoring, combined with continuous autonomic parameter recording, addresses the limitations of existing methods by accurately identifying ictal autonomic disorders and simplifying data analysis, while ensuring patient comfort and safety.
Patent Information
- Authority / Receiving Office
- RU · RU
- Patent Type
- Patents
- Current Assignee / Owner
- GOSUDARSTVENNOE BYUDZHETNOE UCHREZHDENIE ZDRAVOOKHRANENIYA GORODA MOSKVY NAUCHNO PRAKTICHESKIJ PSIKHONEVROLOGICHESKIJ TSENTR IMENI Z P SOLOVEVA DEPARTAMENTA ZDRAVOOKHRANENIYA GORODA MOSKVY
- Filing Date
- 2025-09-09
- Publication Date
- 2026-07-09
Smart Images
Figure 00000001 
Figure 00000002 
Figure 00000003
Abstract
Description
[0001] Field of technology to which the invention relates
[0002] The invention relates to medicine, namely to a method for recording ictal autonomic dysfunction in patients with focal drug-resistant epilepsy during direct electrical stimulation of brain structures using deep electrodes and stereoelectroencephalographic monitoring (stereo-EEG monitoring) as part of pre-surgical diagnostics.
[0003] Technology Level
[0004] The prior art recognizes the need to examine and evaluate the autonomic nervous system in patients with focal drug-resistant epilepsy. Epilepsy is one of the most common neurological diseases (Beghi et al. 2019; Guekht et al. 2010; Singh and Sander 2020) with high psychiatric and somatic comorbidity (Keezer, Sisodiya, and Sander 2016; Rai et al. 2012; Selassie et al. 2014), which can be associated with impaired autonomic regulation of vital functions such as respiration and cardiovascular activity.
[0005] Patients with drug-resistant epilepsy have a higher risk of developing autonomic dysfunction (Thijs et al., 2021). Autonomic dysfunction itself is an independent predictor of chronic cardiovascular disease in the general population. Autonomic dysfunction may underlie the pathogenesis of life-threatening conditions such as myocardial infarction, acute cerebrovascular accident (Degiorgio et al. 2020; DeGiorgio et al. 2021), sudden cardiac death, and sudden unexpected death in epilepsy patients (SUDEP) (Shlobin et al. 2024; Verrier et al. 2020; Verrier and Schachter 2024). SUDEP is a specific condition for this nosology, ranking second after stroke in the structure of mortality in patients with epilepsy (Thurman, Hesdorffer, and French 2014).The SUDEP phenomenon and its causes are not fully understood; however, there is evidence of fatal cardiorespiratory dysfunction developing in the early postictal period of a bilateral tonic-clonic seizure; the cascade of reactions begins with postictal apnea, followed by hypoxemia and terminal asystole (Ryvlin et al. 2013). One possible cause of this condition is the spread of epileptiform activity and the involvement of cortical structures of the central autonomic network (medial prefrontal cortex, insular cortex, amygdala, etc.) in epileptogenesis, resulting in disruption of the interconnections between the cortical and brainstem centers regulating vital functions (Dlouhy et al. 2023).The resulting imbalance of autonomic influences is characterized by a predominance of sympathetic tone, observed at the onset of an attack and for some time after its completion, as evidenced by an increase in the level of catecholamines in the blood (Nass, Motloch, et al. 2019; Simon, Aminoff, and Benowitz 1984). In its effect on the human body, sympathetic hyperactivation can be compared to the effects of chronic stress, one of the leading risk factors for cardiovascular diseases and a predictor of the development of cardiovascular complications (Rosengren et al. 2004). An example of the long-term effect of sympathetic hypertonicity on the cardiovascular system is the phenomenon of the development of stress-induced cardiomyopathies, including in patients with epilepsy (Huynh 2015; Pieroni and Bolognese 2015; Templin et al. 2015). About 80% of focal seizures are accompanied by the development of sinus tachycardia (Leutmezer et al.2003), about 26% of attacks are associated with ictal arterial hypertension (Hampel et al. 2016; Jardine et al. 2001; Nass, Hampel, et al. 2019). The described changes are the most common ictal hemodynamic pattern, the study and early diagnosis of which is of great practical importance. A rarer, but also more formidable ictal disorder of the cardiovascular system is bradyarrhythmia (Rubleva, 2018; Lende van der et al., 2016). It is bradyarrhythmia followed by asystole that is the immediate cause of death in SUDEP (Ryvlin et al., 2013).
[0006] The most vulnerable group for the development of SUDEP are young and middle-aged patients with drug-resistant epilepsy - candidates for neurosurgical treatment (Harden et al. 2017). The incidence of SUDEP-related deaths in this group of patients is 6.3-9.3 per 1000 people per year (Devinsky et al. 2016). The significant likelihood of life-threatening conditions in this group of patients may be associated with a higher prevalence of autonomic disorders (Sathyaprabha et al. 2006). Some authors attribute this to the fact that patients who undergo surgical treatment have a longer history of the disease and a more severe course of the disease that is not amenable to drug control (Lotufo et al. 2012). These patterns dictate the need for screening for autonomic disorders at various stages of examination of such patients, including as part of pre-surgical diagnostics.One option for assessing autonomic parameters in patients with epilepsy is to record them in conjunction with scalp video-electroencephalographic (EEG) monitoring. The combination of these two studies allows us to trace the relationship between the occurrence of epileptiform activity and the recorded autonomic dysfunction, which can play an important role in determining further surgical tactics and assessing the semiology of seizures (Hupp et al. 2022). A specific example of diagnostically significant ictal autonomic disturbances is the detection of ictal central apnea, which is characteristic of focal temporal lobe seizures (Lacuey et al. 2024; N. Lacuey et al. 2019; Tio et al. 2020).
[0007] Despite the undeniable value of video-EEG monitoring, its technical capabilities may in some cases be insufficient to determine the onset and progression of seizures, particularly in patients without epilepsy-associated changes on brain magnetic resonance imaging. In such cases, the gold standard for presurgical diagnosis is stereoelectroencephalographic monitoring using depth electrodes placed in the suspected epileptogenic zone according to the individual electroclinical hypothesis, followed by direct electrical stimulation of brain structures. This procedure allows for the recording of a characteristic ictal EEG pattern and the induction of a typical (similar to an unprovoked) epileptic seizure for the patient (Russkin et al. 2024).Identifying significant cardiovascular and respiratory changes during evoked epileptic seizures is an important clinical task, especially in patients with compromised medical conditions. However, the standard set of parameters (single-channel electrocardiogram) (Tatum et al., 2022) routinely recorded during stereo-EEG monitoring does not allow for a full, continuous assessment of cardiovascular and respiratory function. The most comprehensive information on the state of vital body systems is provided by multisystem recording of autonomic parameters, such as systemic and peripheral blood pressure, heart rate and RR interval duration, respiratory rate, respiratory cycle phase duration, and respiratory flow characteristics.
[0008] Direct electrical stimulation is used worldwide not only for diagnostic but also for research purposes, and is aimed at studying the functions of individual cortical structures that regulate vital parameters, including as part of research into the pathogenesis of SUDEP. Sanchez-Larsen et al. examined the effect of insular cortex stimulation on heart rate and blood pressure parameters. Changes in respiratory rhythm parameters during stimulation of limbic and paralimbic structures, as well as structures associated with the regulation of systemic blood pressure, were studied by Lacuey et al. (Chaitanya et al. 2022; Nuria Lacuey et al. 2019; Pugnaghi et al. 2011; Sanchez-Larsen et al. 2021).
[0009] The closest approach to the proposed method is the cardiorespiratory monitoring protocol during multimodal polygraphy (Hupp et al. 2022), which was selected as a prototype. This protocol describes a method for the simultaneous continuous recording of systemic arterial pressure, heart rate, pulse and tachometry data, and electroencephalography data during video-EEG monitoring, with the ability to record both ictal and postictal events, as well as possible autonomic changes during the interictal period. A distinctive feature of this protocol is the ability to continuously record autonomic parameters, including peripheral arterial pressure values. For example, the authors of this protocol indicate the possibility of placing wearable sensors for up to three days or more.Given the high probability of recording autonomic disturbances during the ictal and interictal periods using the proposed method, several significant limitations cannot be overlooked. Deploying an excessive number of recording sensors for such a long period, in addition to limiting the patient's daily activities, significantly increases the number of movement, respiratory, and other artifacts in the recorded data. The occurrence of these recording artifacts is particularly critical for recording blood pressure and heart rate—key parameters of systemic hemodynamics—impacting the reliability and accuracy of the obtained data, significantly complicating its processing, and requiring additional resources.
[0010] Therefore, there is a need to develop a more comfortable and accurate method for recording ictal autonomic dysfunction in patients with epilepsy, which reduces the number of artifacts when recording autonomic parameters, simplifies further analysis and interpretation of the results, and ensures the identification of life-threatening cardiovascular and respiratory disorders during direct electrical stimulation and induced epileptic seizures, as well as the determination of brain structures associated with the occurrence of ictal autonomic disorders, as well as the registration of autonomic epileptic seizures not accompanied by other clinical manifestations.
[0011] Disclosure of invention
[0012] The aim of this invention is to develop a method for recording ictal autonomic dysfunction in patients with focal drug-resistant epilepsy during stereoelectroencephalographic monitoring using direct electrical stimulation of brain structures using depth electrodes and stereo-EEG monitoring as part of pre-surgical diagnostics.
[0013] Implantation of deep electrodes and direct electrical stimulation of the brain offer a number of unique opportunities. Because electrical stimulation uses stimulus parameters that result in significantly shorter electrographic seizures than those typical for the patient, patients are more likely to be able to describe their sensations during and immediately after the ictal event, which is often difficult during a full-blown unprovoked epileptic seizure. Furthermore, when implanting deep electrodes, one of the most frequently studied areas is the structures of the central autonomic network (insular cortex, medial prefrontal cortex, amygdala) or closely interconnected structures (e.g., hippocampus, parahippocampal gyrus), which play a key role in regulating vital autonomic functions.Therefore, the possibility of recording vegetative changes in such conditions is unique and valuable both for identifying focal vegetative attacks without other clinical manifestations that may remain unrecognized, and for a more detailed and targeted study of the accompanying vegetative symptoms of the onset of an attack (“aura”) and their relationship with brain structures.
[0014] The most clinically valuable function of recording autonomic parameters during direct electrical stimulation and induced seizures is the monitoring of life-threatening conditions. Throughout the procedure, a neurologist and clinical neurophysiologist are present with the patient, regularly assessing the level of consciousness and the semiology of the occurring seizures, allowing for a more accurate interpretation of the described sensations and emerging clinical symptoms. In the event of critical changes in autonomic parameters such as blood pressure, heart rate, or respiratory rate, continuous monitoring allows for prompt interruption of the stimulation procedure and appropriate correction.In our opinion, the combined use of direct electrical stimulation of brain structures and continuous monitoring of respiration and hemodynamic parameters provides opportunities for recording and studying ictal and peri-ictal autonomic disorders, while not being inferior in diagnostic value to foreign analogues.
[0015] The technical result of the claimed invention consists of the effective recording of life-threatening cardiovascular and respiratory disorders during direct electrical stimulation and induced epileptic seizures, the identification of brain structures associated with the occurrence of ictal autonomic dysfunction, and the recording of autonomic epileptic seizures not accompanied by other clinical manifestations. This method is more comfortable for the patient and reduces artifacts when recording autonomic parameters, simplifying subsequent analysis and interpretation of the results.
[0016] The specified technical result is achieved by the proposed method of ictal autonomic dysfunction with simultaneous recording of autonomic regulation parameters in patients with focal drug-resistant epilepsy, including: systemic arterial pressure values, peripheral arterial pressure values for each heartbeat, heart rate or RR interval duration for each heartbeat, respiratory rate, wherein the method includes:
[0017] - preliminary assessment of the patient’s vegetative profile in a clinostatic position by means of parallel continuous recording of the above-described vegetative parameters for at least 5 minutes;
[0018] - continuous monitoring of vegetative parameters during stereo-EEG monitoring with direct electrical stimulation of brain structures using deep electrodes implanted in the suspected epileptogenic zone.
[0019] The following criteria for ictal autonomic dysfunction have been proposed (Zhuravlev et al., PLOS One, 2025; Lacuey et al., Epilepsy Research, 2019):
[0020] 1. Heart rate >100 bpm (tachycardia) provided that the threshold level is crossed by three standard deviations from the pre-stimulation values within 1 minute.
[0021] 2. Heart rate <60 bpm (bradycardia) provided that the threshold level is crossed by three standard deviations from the pre-stimulation values within 1 minute.
[0022] 3. Systolic and / or diastolic blood pressure ≥140 / 90 mmHg (arterial hypertension) provided that the threshold level is crossed by three standard deviations from the pre-stimulation values within 1 minute.
[0023] 4. Systolic and / or diastolic blood pressure <90 / 60 mmHg (arterial hypotension) provided that the threshold level of three standard deviations from the pre-stimulation values is overcome within 1 minute.
[0024] 5. Reduction in the amplitude of respiratory movements >90% for ≥6 seconds (central apnea).
[0025] The claimed method involves a preliminary assessment of the patient's vegetative profile in a clinostatic position in order to record and analyze the initial values of hemodynamic and respiratory parameters; however, the main study occurs precisely during direct electrical stimulation, during which there is a higher probability of recording ictal vegetative disorders directly at the patient's bedside in clear connection with the onset of an attack.
[0026] Real-time monitoring of life-threatening conditions during diagnostic procedures enables rapid response and correction by medical personnel. By performing two studies in parallel and limiting the recording time (only during the stimulation period and a preliminary recording of at least 5 minutes), our proposed method is more comfortable for the patient, reduces the number of artifacts recorded during autonomic parameter recordings, and simplifies subsequent analysis and interpretation.
[0027] It should be noted that monitoring of autonomic parameters does not affect the accuracy of the diagnostic procedure (stereo-EEG monitoring and direct electrical stimulation) and its result, and is also safe for the patient and does not affect the course of the underlying disease and its outcome.
[0028] Monitoring of vegetative parameters is carried out using the following methods:
[0029] - systemic arterial pressure values are recorded from the brachial artery using the oscillometric and / or auscultatory method with a measurement interval of every six minutes;
[0030] - peripheral arterial pressure values are recorded from the digital artery for each heartbeat using the Penaz unloaded artery method;
[0031] - the heart rate or the duration of RR intervals for each heartbeat is determined by recording an electrocardiogram with electrodes placed on the anterior surface of the chest;
[0032] - Respiratory parameters are recorded using a nasal cannula or rheopneumography.
[0033] Determining the heart rate or RR interval sequence using electrocardiogram recording is the gold standard for identifying changes and abnormalities in heart rhythm and assessing its variability. Studying changes in blood pressure in patients with epilepsy is a promising but understudied area due to a number of technical and methodological difficulties in recording it at different periods of an epileptic seizure (Hampel et al., 2016; Nass et al., 2019). Globally, the most common method for measuring systemic arterial pressure is periodic measurement using oscillometric or auscultatory methods. However, their use is associated with a number of limitations and does not allow for the recording of short-term fluctuations in blood pressure beyond the moment of measurement, which is important for patients with epilepsy.A possible solution to this limitation is to record systemic arterial pressure in combination with continuous, noninvasive, beat-to-beat recording of peripheral arterial pressure (Hupp et al., 2022). According to current literature, this method is as accurate as invasive continuous arterial pressure measurement, which is considered the most accurate method of recording arterial pressure (Pour-Ghaz et al., 2019). Since invasive pressure recording is inconvenient for routine practice, continuous noninvasive recording is an affordable alternative, allowing for the study of changes in peripheral arterial pressure without data loss. Nasal cannulae allow for recording tidal volumes and flow parameters using ultrasound sensors, while rheopneumography records chest wall movements. Both methods can be used to determine respiratory rate and detect apnea.
[0034] In preferred embodiments, the patient is placed in a clinostatic position for at least 5 minutes before the preliminary assessment. This ensures stabilization of autonomic parameters and facilitates more reliable examination results.
[0035] Monitoring of vegetative parameters after implantation of deep electrodes is carried out during direct electrical stimulation of brain structures, the parameters of which are determined by the physician based on clinical objectives.
[0036] Brief description of drawings
[0037] Fig. 1 - A fragment of a one-minute recording of vegetative parameters in the patient from Example 1 before the start of direct electrical stimulation. The gray line is the respiratory flow recorded using a nasal cannula; the light green line is the systolic and diastolic blood pressure values for each heartbeat; the blue line is the heart rate values. The purple triangle is an example of an event marker when recording the study. The study time is indicated in minutes and seconds at the bottom of the graph.
[0038] Fig. 2 - A fragment of dynamic changes in autonomic parameters over one minute in the patient in Example 1 after direct electrical stimulation (purple mark), which caused a focal epileptic seizure. The gray line is the respiratory flow recorded using a nasal cannula; the light green line is the systolic and diastolic blood pressure values for each heartbeat; the blue line is the heart rate values. The study time is indicated in minutes and seconds at the bottom of the graph.
[0039] Fig. 3 - cortical structures in the patient according to example No. 1, the first, second and third electrodes (1,2,3) are shown, for electrode two (2) the contacts (4,5) are shown, installed in the projection of the left amygdala.
[0040] Fig. 4 - A fragment of the recording of vegetative parameters in the patient from Example 2 for one minute before the start of direct electrical stimulation. The gray line is the respiratory flow recorded using a nasal cannula; the light green line is the systolic and diastolic blood pressure values for each heartbeat; the blue line is the heart rate values. The study time is indicated in minutes and seconds at the bottom of the graph.
[0041] Figure 5 - A fragment of dynamic changes in autonomic parameters over one minute in the patient in Example 2 after direct electrical stimulation (purple mark), which caused a focal epileptic seizure. The gray line is the respiratory flow recorded using a nasal cannula; the light green line is the systolic and diastolic blood pressure values for each heartbeat; the blue line is the heart rate values. The study time is indicated in minutes and seconds at the bottom of the graph.
[0042] Fig. 6 - A fragment of a one-minute recording of vegetative parameters in the patient from Example 3 before the start of direct electrical stimulation. The gray line is the respiratory flow recorded using a nasal cannula; the light green line is the systolic and diastolic blood pressure values for each heartbeat; the blue line is the heart rate values. The purple triangle is an example of an event marker when recording the study. The study time is indicated in minutes and seconds at the bottom of the graph.
[0043] Fig. 7 - A fragment of a recording of dynamic changes in vegetative parameters over one minute in the patient in Example 3 after direct electrical stimulation (purple mark), which caused a focal epileptic seizure. The gray line is the respiratory flow recorded using a nasal cannula; the light green line is the systolic and diastolic blood pressure values for each heartbeat; the blue line is the heart rate values. The study time is indicated in minutes and seconds at the bottom of the graph.
[0044] Fig. 8 - cortical structures in the patient according to example No. 3, the first and second are shown (1,2), for electrode two (2) contacts are shown (4,5), installed in the projection of the right amygdala.
[0045] Implementation of the invention
[0046] Patients with focal drug-resistant epilepsy who are candidates for neurosurgical treatment undergo a baseline assessment of cardiovascular and respiratory autonomic control upon admission and after implantation of deep electrodes in the suspected epileptogenic zone to identify clinical and subclinical signs of autonomic dysfunction. This assessment is performed in the patient's ward at the bedside or in a separate room, under comfortable conditions, after excluding caffeine- and nicotine-containing foods and beverages. A cuff is placed on the right arm to periodically measure systemic arterial pressure using the oscillometric or auscultatory method at 6-minute intervals. A photoplethysmographic cuff with an optometric sensor is placed on the left hand to record beat-to-beat arterial pressure using the Penaz unloaded artery method.Electrodes are placed on the anterior chest surface to record at least one electrocardiogram lead: in the left hypochondrium (positive) and the right and left subclavian regions (negative and ground, respectively). Respiratory rate is recorded using a nasal cannula and / or rheopneumography. Before recording, the patient lies down or sits for at least 5 minutes to stabilize hemodynamic parameters. After this time, autonomic parameters are recorded at rest for at least 5 minutes. During the examination, the patient is asked to relax as much as possible to avoid any adverse effects (emotional or muscular tension) on the cardiovascular system and minimize myographic artifacts.
[0047] After determining the patient's baseline autonomic parameters, diagnostic direct electrical stimulation of the brain structures is performed. This procedure is performed at the patient's bedside by a clinical neurophysiologist using a cortical stimulator under stereo-EEG monitoring. The procedure aims to provoke typical epileptic seizures in the patient in order to determine the seizure onset zone and the boundaries of the epileptogenic zone subject to surgical removal. Stimulation parameters are selected to record a characteristic ictal electrographic pattern with the patient's typical seizure sensations and typical semiology.
[0048] A preliminary discussion with the patient explains the purpose of the procedure and the expected effects. A clinical neurophysiologist describes any sensations that may arise during the diagnostic procedure and informs the patient about the stages of the examination and their specific features. During the examination, the patient is placed in a comfortable position in bed, with sensors placed to record autonomic parameters using the method described above. If autonomic or electrographic changes are detected, the neurophysiologist and neurologist verify the presence of subjective sensations and record the described changes in the patient's general condition.
[0049] A clinical neurophysiologist delivers electrical impulses to a pair of adjacent contacts of a deep electrode located in the gray matter. Stimulation parameters are determined by the clinical neurophysiologist based on the current clinical task. Autonomic parameters are continuously monitored. Each electrical impulse is marked on the recording, indicating the onset of stimulation. If clinically significant autonomic changes are detected, direct electrical stimulation is suspended until hemodynamic and respiratory parameters stabilize. At this point, the patient is assessed by a neurologist and describes the sensations experienced.
[0050] At the end of the study, an analysis is carried out of the relationship between the recorded ictal autonomic changes and electrographic seizures that occur during stimulation of brain structures.
[0051] The embodiment of the invention is disclosed in the following examples.
[0052] Patient No. 1.
[0053] Male, 34 years old.
[0054] The duration of epilepsy is 10 years, the course is established to be drug-resistant (frequency of attacks is 5-6 times per month).
[0055] Chronic diseases: denies, not recorded in accompanying documentation.
[0056] Registration of autonomic parameters before direct electrical stimulation did not reveal autonomic dysfunction, except for elevated diastolic blood pressure (Fig. 1, Table 1).
[0057] Table 1. Blood pressure, heart rate, and respiratory rate values for the patient in Example No. 1 during the minute before the start of direct electrical stimulation.
[0058] Average value (per 1 minute) Maximum value Minimum value Systolic blood pressure (mmHg) 123 132 114 Diastolic blood pressure (mmHg) 96 104 91 Heart rate (bpm) 84 92 76 Respiratory rate (breaths per minute) 12,7 NA NA
[0059] During electrical stimulation, several epileptic seizures were recorded, one of which was a focal motor seizure with impaired consciousness. This seizure was accompanied by a decrease in blood pressure and heart rate, meeting the criteria for ictal hypotension and ictal bradycardia. According to the obtained data, the recorded ictal autonomic dysfunction is associated with seizure origination in the medial temporal lobe, specifically the left amygdala. (Figs. 2, 3, Table 2).
[0060] Table 2. Blood pressure, heart rate, and respiratory rate values for the patient in Example 1 for one minute after direct electrical stimulation that caused a focal epileptic seizure.
[0061] Average value (per 1 minute) Maximum value Minimum value Systolic blood pressure (mmHg) 106 128 66 Diastolic blood pressure (mmHg) 82 102 47 Heart rate (bpm) 83 110 56 Respiratory rate (breaths per minute) 10,7 NA NA
[0062] Patient No. 2.
[0063] Male, 23 years old.
[0064] The duration of epilepsy is 6 years, the course is established to be drug-resistant (frequency of seizures up to 8 per month).
[0065] Chronic diseases: tension headache, denies other chronic diseases.
[0066] Registration of vegetative parameters before direct electrical stimulation revealed signs of lability of blood pressure and heart rate (Fig. 4, Table 3).
[0067] Table 3. Blood pressure, heart rate, and respiratory rate values for the patient in Example No. 2 during the minute before the start of direct electrical stimulation.
[0068] Average value (per 1 minute) Maximum value Minimum value Systolic blood pressure (mmHg) 105 130 84 Diastolic blood pressure (mmHg) 55 78 35 Heart rate (bpm) 64 80 55 Respiratory rate (breaths per minute) 20,3 NA NA
[0069] During direct electrical stimulation, one focal non-motor seizure without impairment of consciousness was recorded from the left orbitofrontal region. Ictal autonomic dysfunction was recorded, manifested by increased blood pressure values and corresponding ictal hypertension. (Fig. 5, Table 4).
[0070] Table 4. Blood pressure, heart rate, and respiratory rate values for patient No. 2 for one minute after direct electrical stimulation that caused a focal epileptic seizure.
[0071] Average value (per 1 minute) Maximum value Minimum value Systolic blood pressure (mmHg) 143 157 123 Diastolic blood pressure (mmHg) 92 104 77 Heart rate (bpm) 87 104 61 Respiratory rate (breaths per minute) 13,4 NA NA
[0072] Patient No. 3.
[0073] Female, 42 years old.
[0074] The disease has been ongoing for 16 years, with a drug-resistant course (frequency of attacks up to 10 times a month with a tendency to recur).
[0075] Chronic diseases: denies, not recorded in medical records.
[0076] Registration of autonomic parameters before direct electrical stimulation revealed no signs of autonomic dysfunction (Fig. 6, Table 5).
[0077] Table 5. Blood pressure, heart rate, and respiratory rate values for the patient in Example No. 3 during the minute before the start of direct electrical stimulation.
[0078] Average value (per 1 minute) Maximum value Minimum value Systolic blood pressure (mmHg) 107 112 104 Diastolic blood pressure (mmHg) 71 76 67 Heart rate (bpm) 61 67 56 Respiratory rate (breaths per minute) 15,6 NA NA
[0079] During direct electrical stimulation, a focal motor seizure with impaired consciousness was recorded originating in the medial regions of the right temporal lobe, specifically the amygdala. At the onset of the seizure, ictal autonomic dysfunction was recorded, manifested by increased systemic arterial pressure and heart rate, corresponding to the definition of ictal hypertension and ictal tachycardia. In addition to changes in hemodynamic parameters, a threatening episode of almost complete cessation of respiratory movements was recorded, assessed as ictal apnea lasting 30 seconds. (Figs. 7, 8, Table 6).
[0080] Table 6. Blood pressure, heart rate, and respiratory rate values for patient No. 3 for one minute after direct electrical stimulation that caused a focal epileptic seizure.
[0081] Average value (per 1 minute) Maximum value Minimum value Systolic blood pressure (mmHg) 139 168 116 Diastolic blood pressure (mmHg) 127 153 74 Heart rate (bpm) 135 174 59 Respiratory rate (breaths per minute) 22,6 NA Apnea lasting 30 seconds
[0082] These examples confirm the applicability of the claimed method, as well as the effective registration of life-threatening cardiovascular and respiratory disorders during direct electrical stimulation and induced epileptic seizures, the determination of brain structures associated with the occurrence of ictal autonomic dysfunction, and the registration of autonomic epileptic seizures not accompanied by other clinical manifestations.
Claims
1. A method for recording cardiovascular and respiratory disorders in patients with focal drug-resistant epilepsy, including a preliminary assessment of the patient's autonomic profile in a clinostatic position by continuously recording the autonomic parameters for at least 5 minutes: systemic arterial pressure, peripheral arterial pressure per heartbeat, heart rate or duration of RR intervals per heartbeat, respiratory rate, then stereo-EEG monitoring is carried out with direct electrical stimulation of brain structures using deep electrodes implanted in the suspected epileptogenic zone, during which the specified vegetative parameters are recorded, and in case of detection of deviations from the group: heart rate >100 bpm, provided that the threshold level of three standard deviations from pre-stimulation values is overcome within 1 minute; heart rate <60 bpm, provided that the threshold level of three standard deviations from pre-stimulation values is overcome within 1 minute; systolic and / or diastolic blood pressure ≥140 / 90 mmHg, provided that the threshold level of three standard deviations from pre-stimulation values is overcome within 1 minute; systolic and / or diastolic blood pressure <90 / 60 mmHg, provided that the threshold level of three standard deviations from pre-stimulation values is overcome within 1 minute; a decrease in the amplitude of respiratory movements of >90% for ≥6 seconds, Cardiovascular and respiratory disorders are recorded in patients with focal drug-resistant epilepsy.
2. The method according to paragraph 1, characterized in that the values of systemic arterial pressure are recorded from the brachial artery using the oscillometric and / or auscultatory method with a measurement interval of every six minutes; Peripheral arterial pressure values are recorded from the digital artery for each heartbeat using the Penaz unloaded artery method; The heart rate or the duration of RR intervals for each heartbeat is determined by recording an electrocardiogram with electrodes placed on the anterior surface of the chest; Respiratory parameters are recorded using a nasal cannula or rheopneumography.
3. The method according to paragraph 1, characterized in that before the preliminary assessment, the patient is placed in a clinostatic position for at least 5 minutes.