Exercise-induced central and peripheral sympathetic activity in a community-based group of epilepsy patients differ from healthy controls.

Ictal and interictal activity within the autonomic nervous system is characterized by a sympathetic overshoot in people with epilepsy. This autonomic dysfunction is assumed to be driven by alterations in the central autonomic network. In this study, exercise-induced changes of the interrelation of central and peripheral autonomic activity in patients with epilepsy was assessed. 21 patients with epilepsy (16 seizure-free), and 21 healthy matched controls performed an exhaustive bicycle ergometer test. Immediately before and after the exercise test, resting state electroencephalography measurements (Brain Products GmbH, 128-channel actiCHamp) of 5 min were carried out to investigate functional connectivity assessed by phase locking value in source space for whole brain, central autonomic network and visual network. Additionally, 1-lead ECG (Brain products GmbH) was performed to analyze parasympathetic (root mean square of successive differences (RMSSD) of the heart rate variability) and sympathetic activity (electrodermal activity (meanEDA)). MeanEDA increased (p < 0.001) and RMSSD decreased (p < 0.001) from pre to post-exercise in both groups. Correlation coefficients of meanEDA and central autonomic network functional connectivity differed significantly between the groups (p = 0.004) after exercise. Both patients with epilepsy and normal control subjects revealed the expected physiological peripheral autonomic responses to acute exhaustive exercise, but alterations of the correlation between central autonomic and peripheral sympathetic activity may indicate a different sympathetic reactivity after exercise in patients with epilepsy. The clinical relevance of this finding and its modulators (seizures, anti-seizure medication, etc.) still needs to be elucidated.

Home-Based Measurements of Nocturnal Cardiac Parasympathetic Activity in Athletes during Return to Sport after Sport-Related Concussion.

Sport-related concussions (SRC) are characterized by impaired autonomic control. Heart rate variability (HRV) offers easily obtainable diagnostic approaches to SRC-associated dysautonomia, but studies investigating HRV during sleep, a crucial time for post-traumatic cerebral regeneration, are relatively sparse. The aim of this study was to assess nocturnal HRV in athletes during their return to sports (RTS) after SRC in their home environment using wireless wrist sensors (E4, Empatica, Milan, Italy) and to explore possible relations with clinical concussion-associated sleep symptoms. Eighteen SRC athletes wore a wrist sensor obtaining photoplethysmographic data at night during RTS as well as one night after full clinical recovery post RTS (>3 weeks). Nocturnal heart rate and parasympathetic activity of HRV (RMSSD) were calculated and compared using the Mann-Whitney U Test to values of eighteen; matched by sex, age, sport, and expertise, control athletes underwent the identical protocol. During RTS, nocturnal RMSSD of SRC athletes (Mdn = 77.74 ms) showed a trend compared to controls (Mdn = 95.68 ms, p = 0.021, r = -0.382, p adjusted using false discovery rate = 0.126) and positively correlated to "drowsiness" (r = 0.523, p = 0.023, p adjusted = 0.046). Post RTS, no differences in RMSSD between groups were detected. The presented findings in nocturnal cardiac parasympathetic activity during nights of RTS in SRC athletes might be a result of concussion, although its relation to recovery still needs to be elucidated. Utilization of wireless sensors and wearable technologies in home-based settings offer a possibility to obtain helpful objective data in the management of SRC.

Neurophysiological Markers to Guide Return to Sport After Sport-Related Concussion.

SUMMARY: Sport-related concussion (SRC) has been defined as a subset of mild traumatic brain injury (mTBI), without structural abnormalities, reflecting a functional disturbance. Over the past decade, SRC has gained increasing awareness and attention, which coincides with an increase in incidence rates. Because this injury has been considered one of the most challenging encounters for clinicians, there is a need for objective biomarkers to aid in diagnosis (i.e., presence/severity) and management (i.e., return to sport) of SRC/mTBI.The primary aim of this article was to present state-of-the-art neurophysiologic methods (e.g., electroencephalography, magnetoencephalography, transcranial magnetic stimulation, and autonomic nervous system) that are appropriate to investigate the complex pathophysiological process of a concussion. A secondary aim was to explore the potential for evidence-based markers to be used in clinical practice for SRC management. The article concludes with a discussion of future directions for SRC research with specific focus on clinical neurophysiology.

Post-concussion symptoms and clinical reaction time performance of athletes with a history of concussion.

BACKGROUND: The symptom presentation after sport-related concussion is highly subjective, while the clinical test of reaction time (RT) has been presented as an objective tool to the effects of sport-related concussion. A multimodal assessment approach supports concussion management; therefore, it is appropriate to explore the relationship between modals. The aim of the present study is to investigate the relationship of clinical RT and post-concussion symptom (PCS) score, number of experienced concussions, and time since concussion. METHODS: Based on retrospective concussion history, 53 athletes were selected for this study. Athletes were questioned using a standardized questionnaire to obtain concussion history data, such as number of cumulative concussions and date of most recent concussion. Symptom scores were gathered through Sport Concussion Assessment Tool. A clinical RT test was used to obtain RT data. RESULTS: A significant positive correlation was found between RT and the PCS score. A linear regression revealed that the PCS score but neither the cumulative number of experienced concussions, nor the time post-concussion significantly predicts increased RT. Reaction time positively correlates with the symptoms neck pain, dizziness, balance problems, light sensitivity, feeling slowed down, feeling like in a fog, do not feel right, drowsiness, and irritability. CONCLUSIONS: This study presents that the PCS score particularly predicts increased RT after sport-related concussions. Furthermore, a specific set of symptoms significantly impacts the RT of athletes. The results suggest that not a single symptom drives the relationship between PCS score and RT, highlighting the heterogeneity of this injury.

Fitness, performance, and cardiac autonomic responses to exercise in people with epilepsy.

People with epilepsy (PWE) are less fit and have an increased risk of sudden cardiac death. Imbalances within the autonomic nervous system (ANS) are believed to mediate some of those effects. However, results are mostly derived from patients whose seizures are refractory to medical therapy. In this study, an exhaustive bicycle ergometer test was delivered to 25 PWE (19 seizure free in the last 6 months) recruited in a community-based setting and 25 age-, sex-, and BMI-matched healthy controls. During the exercise test a 12-channel ECG was recorded and spirometry was carried out to determine the maximal oxygen uptake (VO2peak) as the gold standard to assess fitness. Before and after exercise, heart rate variability (HRV) and electrodermal activity (EDA) were measured along with an electroencephalogram (EEG). Blood samples were collected to determine anti-seizure drug (ASD) serum levels and physical activity of daily living was evaluated via the International Physical Activity Questionnaire (IPAQ). People with epilepsy and healthy controls were similarly fit and physically active. However, PWE had a lower maximum heart rate, a lower heart rate reserve, and a lower chronotropic index. The ratio between low- to high-frequency HRV changes (LF/HF ratio) was lower in PWE. Two patients with idiopathic genetic epilepsies revealed generalized interictal epileptiform discharges only after, but not before exercise. However, post-exercise EEG measurement was three times longer than pre-exercise and those patients did not report exercise induced seizures in the history. Besides epileptogenesis, anti-seizure medications may also contribute to those autonomic differences.

Impaired recognition of nonverbal expressions of emotions in depressed individuals.

INTRODUCTION: Depressive individuals are impaired in the recognition of emotions in others'. Recent research suggests that the recognition of nonverbal expressions of emotions in other people may depend on the analysis of bodily rather than facial expressions. Therefore, we investigated if an impaired recognition of emotions by depressed individuals is body part specific. METHODS: Clinically diagnosed depressed and healthy matched controls were instructed to identify nonverbal expressions of positive (happiness), neutral, and negative emotions (sadness) via the face, the body, or the body and face. RESULTS: Depressed participants responded significantly less correctly overall when compared to non-depressed individuals. The recognition of nonverbal expressions of happiness by the body negatively predicted the Beck Depression Inventory II (BDI-II) score. DISCUSSION: The data revealed that the impaired recognition of nonverbal expressions of emotions in others by depressed individuals is not body part specific. Nevertheless, depressive symptoms seem to be related to the recognition of bodily expressions of happiness. Future studies must address whether impairments of depressive individuals are related to nonverbal expressions of the whole body.