epilepsiaEpilepsy and paroxysmal conditionsЭпилепсия и пароксизмальные состояния2077-83332311-4088IRBIS LLC10.17749/2077-8333/epi.par.con.2026.279epilepsia-1354Research ArticleSCIENTIFIC SURVEYSНАУЧНЫЕ ОБЗОРЫIctal, postictal and interictal autonomic disturbances in patients with focal epilepsyИктальные, постиктальные и интериктальные вегетативные нарушения у пациентов с фокальной эпилепсиейhttps://orcid.org/0000-0002-7682-6672МаксимоваМ. Ю.MaximovaM. Yu.

Максимова Марина Юрьевна, д.м.н., проф.

WoS ResearcherID: C-7408-2012. Scopus Author ID: 7003900736

Волоколамское ш., д. 80, Москва 125367

Marina Yu. Maximova, Dr. Sci. Med., Prof.

WoS ResearcherID: C-7408-2012. Scopus Author ID: 7003900736

80 Volokolamskoe Shosse, Moscow 125367

ncnmaximova@mail.ruhttps://orcid.org/0000-0002-6381-2925БрутянА. Г.BroutianA. G.

Брутян Амаяк Грачевич, к.м.н.

Scopus Author ID: 57214245733

Волоколамское ш., д. 80, Москва 125367

Amayak G. Broutian, PhD 

Scopus Author ID: 57214245733

80 Volokolamskoe Shosse, Moscow 125367

https://orcid.org/0000-0002-0908-8040БерестоваЕ. А.BerestovaE. A.

Берестова Елизавета Алексеевна

Волоколамское ш., д. 80, Москва 125367

Elizaveta А. Berestova 

80 Volokolamskoe Shosse, Moscow 125367

Федеральное государственное бюджетное научное учреждение «Российский центр неврологии и нейронаук»РоссияResearch Center of NeurologyRussian Federation202603082026182181–190Copyright © Maximova M.Y., Broutian A.G., Berestova E.A., 20262026Максимова М.Ю., Брутян А.Г., Берестова Е.А.Maximova M.Y., Broutian A.G., Berestova E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epilepsia.su/jour/article/view/1354

Focal epilepsy is associated with prominent autonomic disturbances occurring during the ictal, postictal, and interictal periods. Differential assessment of such disorders is important for improving the effectiveness of antiseizure therapy and reducing the risk of sudden unexpected death in epilepsy (SUDEP). The review summarizes current concepts regarding the pathophysiological mechanisms, clinical semiology, and diagnostic significance of autonomic manifestations in patients with focal epilepsy. During the ictal period, the most commonly observed abnormalities include changes in heart rhythm (tachycardia and, less commonly, bradycardia), respiratory disturbances (apnea and hyperventilation), gastrointestinal symptoms (epigastric aura), and pilomotor reactions. Postictal autonomic disturbances include arterial hypotension, hypersalivation, aspiration phenomena, and postictal arrhythmia, all of which correlate with SUDEP risk. Interictal disturbances are characterized by reduced heart rate variability, arterial hypertension, neurogenic bladder dysfunction, and thermoregulatory disorders, reflecting suppression of autonomic nervous system activity. Autonomic disturbances in focal epilepsy represent clinically significant phenomena that nevertheless are often inadequately assessed in routine clinical practice. Detailed analysis of these disorders may help refine epileptogenic zone localization, improve risk stratification for life-threatening conditions, and contribute to a more personalized therapeutic approach.

Фокальная эпилепсия ассоциирована с выраженными вегетативными нарушениями, возникающими в иктальном, постиктальном и интериктальном периодах. Дифференциальная диагностика таких нарушений имеет значение для повышения эффективности противоэпилептической терапии и снижения риска развития внезапной необъяснимой смерти при эпилепсии (англ. sudden unexpected death in epilepsy, SUDEP). В обзоре систематизированы современные представления о патофизиологических механизмах, клинической семиотике и диагностической значимости вегетативных проявлений у пациентов с фокальной эпилепсией. В иктальном периоде наиболее часто регистрируются изменения сердечного ритма (тахикардия, реже – брадикардия), дыхательные нарушения (апноэ, гипервентиляция), гастроинтестинальные симптомы (эпигастральная аура), а также пиломоторные реакции. Постиктальные вегетативные расстройства включают артериальную гипотензию, гиперсаливацию, аспирационные явления и постприступную аритмию, которые коррелируют с риском развития SUDEP. Интериктальные нарушения проявляются снижением вариабельности сердечного ритма, артериальной гипертензией, нейрогенной дисфункцией мочевого пузыря и терморегуляторными расстройствами, что отражает подавление активности автономной нервной системы. Вегетативные нарушения, возникающие при фокальной эпилепсии, представляют собой значимые клинические феномены, которые, тем не менее, зачастую не получают адекватной оценки в рутинной клинической практике. Детальный анализ указанных нарушений способствует уточнению локализации эпилептогенной зоны, совершенствованию стратификации риска развития жизнеугрожающих состояний, а также персонализации терапевтической стратегии.

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The authors declare that there are no conflicts of interest present.