Investigating the Relationship Between Pre-Ictal Heart Rate Variability and Seizure Duration in Focal Epilepsy

Overview

Seizures impact 10% of the global population, with epilepsy developing in 1-2%. Seizure duration is an important marker of severity, with longer duration leading to increased morbidity and mortality. As the heart and brain are interlinked with the autonomic nervous system, electrocardiogram (ECG) data can be used to study seizures. While heart rate variability (HRV), a measure derived from ECG, has been studied for seizure detection, its relationship to severity, with seizure duration as an index, remains largely unexplored. This study investigates whether pre-ictal HRV, quantified using the root mean square successive differences (RMSSD), is associated with subsequent seizure duration in patients with focal epilepsy. Data was obtained from the SeizeIT2 dataset containing synchronized ECG and EEG recordings with multiple vigilance states and seizure types of 125 patients in epilepsy monitoring units (EMUs). Pre-ictal HRV was calculated over a 300-second window preceding seizure onset, and seizure duration was log-transformed to account for skew. Linear regression was applied to model seizure duration as an outcome of RMSSD values, followed by a multivariable regression model with interaction terms and patient-level clustering. A total of 843 seizures were analyzed, and lower RMSSD was significantly associated with a longer seizure duration, specifically for focal aware seizures (β = −0.0147, p = 0.011). These findings suggest that pre-ictal autonomic measures may help identify patients at risk for prolonged seizures in specific focal seizure types, potentially contributing to the development of personalized epilepsy monitoring and devices that improve patient quality of life or enable earlier treatment.

Competition history

• CSEF 2026 Medicine & Physiology (Senior Division) · Entry S-15-13

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