Key result
The ictal ECG-derived alpha metric was significantly elevated in SUDEP patients compared to non-SUDEP patients (p < 0.0001), yielding a logistic classifier with an AUC of 94%.
Why the study?
Previous case-control studies failed to identify ECG features predictive of sudden unexpected death in epilepsy risk, indicating a need for novel ECG metrics.
Does an ictal ECG-derived metric (alpha) based on cross-frequency phase-phase coupling predict the risk of sudden unexpected death in epilepsy (SUDEP) in patients with drug-resistant focal epilepsy?
Case-Control (n=21)
Yes
Does an ictal ECG-derived metric (alpha) based on cross-frequency phase-phase coupling predict the risk of sudden unexpected death in epilepsy (SUDEP) in patients with drug-resistant focal epilepsy?
p-value: p=<0.0001
Introduction: Previous case-control studies of sudden unexpected death in epilepsy (SUDEP) patients failed to identify ECG features (peri-ictal heart rate, heart rate variability, corrected QT interval, postictal heart rate recovery, and cardiac rhythm) predictive of SUDEP risk. This implied a need to derive novel metrics to assess SUDEP risk from ECG. Methods: We applied Single Spectrum Analysis and Independent Component Analysis (SSA-ICA) to remove artifact from ECG recordings. Then cross-frequency phase-phase coupling (PPC) was applied to a 20-s mid-seizure window and a contour of -3 dB coupling strength was determined. The contour centroid polar coordinates, amplitude (alpha) and angle (theta), were calculated. Association of alpha and theta with SUDEP was assessed and a logistic classifier for alpha was constructed. Results: < 0.001). Theta showed no significant difference between patient populations. The receiver operating characteristic (ROC) of a logistic classifier for alpha resulted in an area under the ROC curve (AUC) of 94% and correctly classified two test SUDEP patients. Discussion: , which highlights non-linear interactions between two rhythms in the ECG, and is predictive of SUDEP risk.
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Gravitis et al. (2023) conducted a case-control in Epilepsy (SUDEP risk) (n=21). Ictal ECG alpha metric vs. Non-SUDEP patients was evaluated on Alpha metric (contour centroid amplitude) during generalized tonic-clonic seizures (p=<0.0001). The ictal ECG-derived alpha metric was significantly elevated in SUDEP patients compared to non-SUDEP patients (p < 0.0001), yielding a logistic classifier with an AUC of 94%.
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