EKG abnormalities in children and adolescents with symptomatic temporal lobe epilepsy
Mayer H, Benninger F, Urak L, Plattner B, Geldner J, and Feucht M (2004) EKG abnormalities in children and adolescents with symptomatic temporal lobe epilepsy. Neurology 63:2 324–8.
Abstract: BACKGROUND: Changes in cardiac rate and rhythm are often found in adult patients with temporal lobe epilepsy (TLE) and could be involved in the pathogenesis of sudden unexplained death (SUDEP). However, little is known about heart rate (HR) variability in pediatric patients with TLE. OBJECTIVES: To investigate ictal and peri-ictal HR abnormalities in children and adolescents with medically refractory symptomatic TLE and to determine the influence of focus localization and laterality. METHODS: Patients younger than 18 years, with drug-resistant unilateral symptomatic TLE and presenting with at least one habitual complex partial seizure (CPS) during presurgical noninvasive video-EEG monitoring, were enrolled. Synchronous single-channel EKG recordings were analyzed during the preictal, ictal, and postictal stages. RESULTS: Twenty patients fulfilled the inclusion criteria. Seventy-two temporal lobe seizures (TLSs) were analyzed. Ictal tachycardia was found in 71 TLSs (98%), whereas ictal bradycardia was not observed. During preictal stages, tachycardia occurred in 20 seizures and mild bradycardia in 3. In 44 seizures (62%), tachycardia was still present >60 seconds after EEG seizure termination. Cluster analysis revealed significant differences in HR evolution depending on location and side of seizure onset: Early and high HR increase was primarily associated with right mesial TLSs. CONCLUSIONS: Cardiovascular dysregulation is common during temporal lobe CPSs in children. These results confirm a right hemispheric lateralization of sympathetic cardiac control.
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Context
- Retrospective review of patients under 18 years of age who underwent surgery for temporal lobe epilepsy. EKG records were evaluated algorithmically for HR measurement. Preictal increase or decrease in HR was seen in a subset of patients. Ictal changes in HR across all patients could be treated as falling into one of 4 patterns. These patterns of change in HR seemed to have some correlation with seizure focus, suggesting differential distribution of autonomic influence in cortex and thalamus. Prolonged bradycardia after seizure termination was seen in one case and a period of oscillation in HR postically was seen in another case.