Heart rate changes and ECG abnormalities during epileptic seizures: Prevalence and definition of an objective clinical sign

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Zijlmans M, Flanagan D, and Gotman J (2002) Heart rate changes and ECG abnormalities during epileptic seizures: Prevalence and definition of an objective clinical sign. Epilepsia 43:8 847–54.

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Abstract: PURPOSE: To determine the prevalence of heart rate changes and ECG abnormalities during epileptic seizures and to determine the timing of heart rate changes compared to the first electrographic and clinical signs. To assess the risk factors for the occurrence of ECG abnormalities. METHODS: We analyzed retrospectively 281 seizures in 81 patients with intractable epilepsy who had prolonged video-EEG and two-channel ECG. The nature and timing of heart rate changes compared to the electrographic and clinical seizure onset was determined. The ictal period (including one minute preictally and three minutes postictally) was analyzed for cardiac arrhythmias, conduction and repolarization abnormalities. Risk factors for cardiac abnormalities were investigated using parametric and non-parametric statistics. RESULTS: There was an increase in heart rate of at least 10 beats/minute in 73% of seizures (93% of patients) and this occurred most often around seizure onset. In 23% of seizures (49% of patients) the rate increase preceded both the electrographic and the clinical onset. ECG abnormalities were found in 26% of seizures (44% of patients). One patient had an asystole for 30 seconds. Long seizure duration increased the occurrence of ECG abnormalities. No other risk factor was found. CONCLUSIONS: Heart rate changes occur frequently and occur around the time or even before the earliest electrographic or clinical change. The change can clarify the timing of seizure onset and the specific rate pattern may be useful for seizure diagnosis and for automatic seizure detection. ECG abnormalities occur often and repeatedly in several seizures of the same patient.

Keywords: Heart rate—ECG—Epilepsy—Seizureonset—Asystole

Context

  • Analysis of 281 seizures in 81 patients using simultaneous EEG and EKG during seizure monitoring to address time of EKG change relative to seizure onset. 73% of seizures showed an increase in heart rate of 10 beats per minute or more. Abnormal findings were seen on EKG in roughly one-fourth of patients, and these were more common with longer seizure. There was one incidence of asystole, which lasted 30 s. Change in heart rate was generally either at or just prior to the onset of the seizure.

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