Current View of Autonomic Findings During Epileptic Seizures

Autonomic findings during epileptic seizures frequently associate other ictal symptoms or may appear isolated. These changes are often overshadowed by other dramatic motor symptoms and not recognized. Cardiovascular system changes are thought to play a particular role in sudden unexplained death in epilepsy (SUDEP). In the literature, information about the features of peri-ictal autonomic symptoms and their lateralizing value are controversial. It is important to identify patients who are at high risk for SUDEP and plan early and appropriate medical treatment, as well as epilepsy surgery options to reduce mortality related with seizures. This paper will review the literature of the frequency of peri-ictal autonomic findings and their lateralizing and localizing information with didactic case examples. Furthermore, the relation between cardiac rhythm disorders, other electroclinical data, and risk of SUDEP will be evaluated.