Autonomic nervous system functioning associated with psychogenic nonepileptic seizures: Analysis of heart rate variability

Sylvie J. M. van der Kruijs*, Kristl E. J. Vonck, Geert R. Langereis, Loe M. G. Feijs, Nynke M. G. Bodde, Richard H. C. Lazeron, Evelien Carrette, Paul A. J. M. Boon, Walter H. Backes, Jaap Jansen, Albert P. Aldenkamp, Pierre J. M. Cluitmans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: Psychogenic nonepileptic seizures (PNESs) resemble epileptic seizures but originate from psychogenic rather than organic causes. Patients with PNESs are often unable or unwilling to reflect on underlying emotions. To gain more insight into the internal states of patients during PNES episodes, this study explored the time course of heart rate variability (HRV) measures, which provide information about autonomic nervous system functioning and arousal. Methods: Heart rate variability measures were extracted from double-lead electrocardiography data collected during 1-7 days of video-electroencephalography monitoring of 20 patients with PNESs, in whom a total number of 118 PNESs was recorded. Heart rate (HR) and HRV measures in time and frequency domains (standard deviation of average beat-to-beat intervals (SDANN), root mean square of successive differences (RMSSD), high-frequency (HF) power, low-frequency (LF) power, and very low-frequency (VLF) power) were averaged over consecutive five-minute intervals. Additionally, quantitative analyses of Poincare plot parameters (SD1, SD2, and SD1/SD2 ratio) were performed. Results: In the five-minute interval before PNES, HR significantly (p=0.05) increased (d=2.5), whereas SDANN (d=-0.03) and VLF power (d=-0.05) significantly decreased. During PNES, significant increases inHF power (d=0.0006), SD1 (d=0.031), and SD2 (d=0.016) were observed. In the five-minute interval immediately following PNES, SDANN (d=0.046) and VLF power (d=0.073) significantly increased, and HR (d=-5.1) and SD1/SD2 ratio (d=-0.14) decreased, compared to the interval preceding PNES. Conclusion: The results suggest that PNES episodes are preceded by increased sympathetic functioning, which is followed by an increase in parasympathetic functioning during and after PNES. Future research needs to identify the exact nature of the increased arousal that precedes PNES.
Original languageEnglish
Pages (from-to)14-19
JournalEpilepsy & Behavior
Publication statusPublished - Jan 2016


  • Psychogenic nonepileptic seizures
  • Conversion disorder
  • Heart rate variability
  • Vagal tone
  • Autonomic nervous system

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