The brain-heart connection: Value of concurrent ECG and EEG recordings in epilepsy management

Figures

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  Fig. 1. Traditional concepts of neural control of cardiac electrical activity focused on afferent tracts (dashed lines) arising from myocardial nerve terminals and reflex receptors (e.g., baroreceptors) that are integrated centrally within hypothalamic and medullary cardiostimulatory and cardioinhibitory brain centers and on central modulation of sympathetic and parasympathetic outflow (solid lines) with little intermediary processing at the level of the spinal cord and within cervical and thoracic ganglia. More recent views incorporate intricate processing within the extraspinal cervical and thoracic ganglia and within the cardiac ganglionic plexus, where interneurons are envisioned to provide new levels of noncentral integration. Release of neurotransmitters from postganglionic sympathetic neurons is believed to enhance excitation in the sino-atrial node and myocardial cells through norepinephrine binding to beta-1 receptors, which enhances adenyl cyclase (AC) activity through intermediary stimulatory G proteins (Gs). Increased parasympathetic outflow enhances postganglionic release and binding of acetylcholine to muscarinic (M2) receptors, and through coupled inhibitory G proteins…

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  Fig. 2. Seizure-induced malignant arrhythmia in an epilepsy monitoring unit patient. Electroencephalogram (EEG) showing the end of a right temporal lobe seizure with electrocardiogram (ECG) revealing a rapid ventricular tachycardia degenerating into pulseless ventricular fibrillation requiring countershock. Patient was a 51 year-old woman with a history of epilepsy since childhood. Reprinted with permission from the American Academy of Neurology [53].

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  Fig. 3. Crescendo in T-wave alternans (TWA) level heralded onset of ventricular tachycardia in a patient with chronic epilepsy. This event occurred on the 4th day of the ECG patch recording and thus the arrhythmia was not recorded by the 24-hour Holter monitor. Reprinted with permission from the American Academy of Neurology [142].

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  Fig. 4. Concurrent recordings of standard lead I wired electrocardiogram (ECG) in association with the electroencephalogram (EEG) recording and wireless ECG patch in an epilepsy monitoring unit (EMU) patient experiencing ventricular premature beats (VPB). The upper tracing illustrates a relatively noisy reading typically associated with the artifacts from body movements of lead wires. The lower tracing illustrates higher quality tracings free of artifacts. The presence and morphology of ECG beats can be readily observed. TWA = T-wave alternans.