OBJECTIVE

The purpose of our study was to investigate the hypothesis of greater severity of autonomic dysfunction in patients with concomitant epileptic and psychogenic non-epileptic seizures (PNES) (main group) compared to patients with exclusively epileptic seizures (comparison group) and healthy subjects (control group).

MATERIAL AND METHODS

The main group included 13 subjects (median age 31 years [Q₁=21 years, Q₃=42 years], 9 females), and the control and comparison groups included 26 people each, comparable by sex and age to the main group. All patients underwent neurological and psychiatric examination, electroencephalography or video-electroencephalographic monitoring, and MRI. All patients had the following tests done: cardiointervalogramm, systolic blood pressure for each heartbeat, and tachogram for 5 minutes of lying down, active verticalization, and 5 minutes of orthostatic position. Heart rate variability in the time and frequency domains (lying) and blood pressure variability in the frequency domain (lying) were analyzed; also, the sensitivity of the arterial baroreflex and the 30:15 index were calculated. Pearson’s Chi-square test, Kruskal—Wallis test, and post hoc Mann—Whitney U-test corrected for multiple Benjamini-Hochberg comparisons were used to compare the parameters.

RESULTS

In comparison with the control group, patients with epilepsy had autonomous regulation disorders as a total decrease in autonomous activity. However, in patients with epileptic seizures and PNES, more severe autonomic regulation disorders were observed, as indicated by a decrease in the 30:15 index and the arterial baroreflex sensitivity during an orthostatic test compared to patients without psychogenic seizures.

CONCLUSION

Patients with epilepsy showed a decrease in the autonomic regulation of the cardiovascular system. However, the concomitant PNES in patients with epilepsy was associated with a greater severity of autonomic dysfunction, in particular, during an orthostatic test.