Non-invasive assessment of cardioregulatory autonomic functions in children with epilepsy

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El-Sayed HL, Kotby AA, Tomoum HY, El-Hadidi ES, El Behery SE, and El-Ganzory AM (2007) Non-invasive assessment of cardioregulatory autonomic functions in children with epilepsy. Acta Neurol Scand 115:6 377–84.

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Abstract: OBJECTIVES: We aimed to evaluate the interictal cardiovascular autonomic functions in pediatric patients with idiopathic epilepsy, both partial and generalized. MATERIALS AND METHODS: The study included 25 patients with idiopathic epilepsy and 50 control subjects. Patients underwent five standardized clinical cardiovascular reflex autonomic tests [resting heart rate (HR), HR response to deep breathing and to Valsalva maneuver, the 30:15 ratio of HR response to standing, and blood pressure response to standing], as well as a 12 lead surface electrocardiogram. Heart rate variability (HRV) was tested via 24-h Holter monitoring and the time domain parameters (SDNN, PNN50, rMSDD) were assessed. Excretion of vanillyl mandelic acid and metanephrine was measured in 24-h urine collection. RESULTS: Clinical reflex autonomic tests showed mild dysfunction in 8%, moderate dysfunction in 44% and severe dysfunction in 4% of patients. The HRV parameter, SDNN, was reduced in all age groups, while rMSDD and PNN50 were reduced only in the older age group. Metanephrine levels were significantly reduced in the patients group. Patients with uncontrolled epilepsy had a significantly higher frequency of autonomic dysfunction as assessed by clinical scoring. CONCLUSION: Cardiac autonomic dysfunction is not uncommon in pediatric patients with epilepsy. Altered cardiovascular regulation seems to be related to the epilepsy itself rather than to the characteristics of the disorder.

Keywords: autonomic function; catecholamine;epilepsy; heart rate variability; pediatrics


  • Study of 25 patients with idiopathic epilepsy and 50 control subjects using autonomic tests, 12 lead EKG, and ambulatory EKG monitoring with several metrics to assess heart rate variability, and measurement of catecholamine metabolites in urine to assess autonomic output. Relative to controls, patients were impaired in clinical autonomic tests, HRV was reduced, and metanephrine levels were reduced, though those of vanillyl mandelic acid, another catecholamine metabolite, were not.


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