Brain–heart functional network dysfunction in temporal lobe epilepsy: A microstate‐based analysis

OBJECTIVE: Epilepsy patients face significantly elevated cardiovascular risks, with cardiac arrhythmias occurring 2-3 times more frequently than in the general population. Current knowledge of brain-heart functional coupling abnormalities in epilepsy, particularly during interictal periods, remains limited. We investigated brain-heart interplay characteristics in temporal lobe epilepsy through synchronized electroencephalographic-electrocardiographic analysis using a synthetic data generation model and microstate analysis. METHODS: , representing bidirectional interactions between brain activity and cardiac components. RESULTS: coupling, patients exhibited significantly reduced mean duration of microstate 3 (.34 ± .09 s vs. .38 ± .07 s, p = .02), increased occurrence rates of microstates 3 and 4 (both p < .001), and altered temporal coverage patterns. Similar abnormalities were observed across all sequences, with patients showing shortened microstate durations, altered occurrence rates, and disrupted temporal coverage. Spatial dissimilarity analysis revealed significant topological abnormalities across all microstates. A logistic regression model incorporating microstate parameters achieved 94.7% diagnostic accuracy for temporal lobe epilepsy, with an F1 score of .952 and an area under the curve of .932. SIGNIFICANCE: Temporal lobe epilepsy is characterized by profound disruptions in brain-heart functional coupling during interictal periods, manifesting as altered microstate topographies and temporal dynamics. These findings establish microstate-based analysis as a promising framework for characterizing brain-heart axis dysfunction in epilepsy.