Autonomic manifestations of epilepsy

Abstract

Abstract: An epileptic fit does not only manifest as bizarre motor activity but can destabilize autonomic functions. Abnormal electrical discharge originating from the cerebral cortex can spreads to involve the autonomic system thus creating a dysfunction of the sympathetic and the parasympathetic which modulate the cardiorespiratory, digestive, genitourinary systems. The autonomic phenomenon can be encountered in simple partial, complex partial, generalised tonic-clonic, absence and generalized tonic seizures. Both the motor and the autonomic components may manifest simultaneously; at times the autonomic symptoms may precede or outlast the motor components. Autonomic features affecting the cardiopulmonary function may be life-threatening and contributes to 8-17% of deaths in individuals with epilepsy. Hypoventilation, apnoea, atrial fibrillation, sinus arrhythmias, atrial and ventricular premature depolarisations, bundle branch block and asystole are known to manifest in the peri-ictal and also in interictal phases of epilepsy. Poor control, and polytherapy in the management of patients, render some epileptics more vulnerable toexcessive excitability of the autonomic nervous system. The aim of this communication, therefore, is to alert and remind healthcare givers on the autonomic phenomena of epileptic fits some of which may result in sudden unexpected death. Clinician should always take a holistic approach in the evaluation of epilepsy patients and watch out especially for cardiorespiratory variability during and in-between attacks.

Key Words: Epilepsy, Autonomic dysfunction.