Introduction from Dr Markus Reuber, editor-in-chief of Seizure
Medicine has advanced at a most impressive pace over the last century and a half. The increase in our understanding of how the body works and how things may stop working properly has gone hand in hand with a continuous increase in the degree of specialization. This process has been self-reinforcing and shows no signs of coming to an end: the astonishing pace of progress could not be maintained without specialization – and thanks to the growth in the volume of available knowledge, the area any individual can claim to have an expert understanding of has been diminishing steadily.
As stated at the outset, this process has delivered impressive results. However, it may have hindered rather than enhanced progress in areas of research which sit between traditional specialty boundaries. The study of the cardiac effects of epileptic discharges, epileptic seizures, antiepileptic drugs and comorbidities closely connected with epilepsy is one such area. Although it has been possible to record and visualize the Electrocardiogram (ECG) since 1878 (1) (whereas the recording of Electroencephalographic (EEG) activity was not described until 1929) (2), and although the ECG is much easier to record than the EEG, inter-, pre- and intra-ictal ECG changes have received surprisingly little attention. Much effort has been invested in identifying pre-ictal indicators of impending epileptic seizures by analyzing highly complex EEG data – in contrast, much simpler ECG data has, until recently, been relatively neglected.
My editor’s choice from this issue of seizure, the review by Katherine Egglestone et al. explores the use of changes in cardiac signals as extra-cerebral biomarkers
of seizures in patients with epilepsy. Whilst the limited evidence so far poses almost as many questions as it provides answers, the available research (and the fact that ‘wearable’ ECG monitoring technology is now very cheap and widely available) suggests that it is worth pursuing the idea of using ECG monitoring as one contributor to effective and reliable multimodal seizure forecasting systems. Being able to identify reliably that a seizure is occurring (or even better: likely to occur) may be a relatively small step for epilepsy research in general, but a giant leap for patients and families worrying about unobserved seizures.
(1) Burdon Sanderson J, Page, F J M.. Experimental results relating to the rhythmical and excitatory motions of the ventricle of the frog heart. Proceedings of the Royal Society 1878;27:410–14.
(2) Berger,H. Über das Elektrenkephalogramm des Menschen. Archiv für Psychiatrie und Nervenkrankheiten 1929;87:527-570.
(3) Eggleston, K; Olin, B; Fisher, R S. Ictal Tachycardia: The Head-Heart Connection.