EKG abnormalities in children and adolescents with symptomatic temporal lobe epilepsy.
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.


OBJECTIVE
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.
Epilepsy Monitoring Unit, Department of Child and Adolescent Neuropsychiatry, University Hospital Vienna, Austria.
H
H
Mayer
F
F
Benninger
L
L
Urak
B
B
Plattner
J
J
Geldner
M
M
Feucht
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D001919:Bradycardia / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004292:Dominance, Cerebral; D004562:Electrocardiography; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D011300:Preoperative Care; D012189:Retrospective Studies; D013610:Tachycardia / Q000209:etiology* / Q000503:physiopathology; D014741:Video Recording
D000927:Anticonvulsants