Ictal, postictal and interictal autonomic disturbances in patients with focal epilepsy

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.

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