Pourmotabbed, Haatef; Doss, Derek J.; Sainburg, Lucas E.; Nobis, William P.; Englot, Dario J.; Morgan, Victoria; Chang, Catie. (2026).听.听Neurology, 107(6), e218470.听
Temporal lobe epilepsy (TLE) is associated with problems in the brain systems that automatically regulate heart rate and breathing, which may contribute to the risk of sudden unexpected death in epilepsy (SUDEP). We examined brain imaging and cardiorespiratory data from 72 patients with drug-resistant TLE and 105 healthy controls. Patients with TLE showed reduced connectivity and tissue volume in the central autonomic network, a group of brain regions involved in regulating involuntary body functions. Reduced brain connectivity was associated with faster breathing and lower variability in heart rate and breathing, while structural changes were linked to clinical features such as generalized seizures and earlier epilepsy onset. In patients studied after epilepsy surgery, changes in brain connectivity were also associated with changes in heart and breathing function. These findings suggest that disruption of the central autonomic network may contribute to cardiorespiratory problems in TLE and could potentially help identify markers of SUDEP risk, although further research is needed.
Figure 1聽Abnormal Cardiorespiratory Function, Autonomic Network Connectivity, and Structural Volume in TLE
(A)Comparison of the breathing rate (BR), respiratory rate variability (RRV), and high-frequency and low-frequency heart rate variability (HF-HRV/LF-HRV) between temporal lobe epilepsy (TLE) and healthy controls (HC). Two-samplettests (2-tailed) were used for statistical comparisons. *p聽< 0.05, **p聽< 0.01, ***p聽< 0.001, false discovery rate (FDR)-corrected across 4 cardiorespiratory measures. (B) Regional differences in functional connectivity (FC) node strength of the central autonomic network between TLE and controls (p聽< 0.05, FDR-corrected across regions; 2-sample聽ttests, 2-tailed). (C) Regional differences in structural volume between TLE and controls (p聽< 0.05, FDR-corrected across regions; 2-sample聽t聽tests, 2-tailed). The FC, cardiorespiratory, and brain volume estimates were adjusted for age and sex. The brain volume estimates were not adjusted for total intracranial volume.