title: Enhanced QT shortening and persistent tachycardia after generalized seizures.
abstract: OBJECTIVE
  Generalized tonic-clonic seizures (GTCS) are a major risk factor for sudden unexpected death in epilepsy (SUDEP). We investigated whether ictal/postictal cardiac features were dependent on seizure type within individual patients.
  
  
  METHODS
  ECG data from patients with medically refractory temporal lobe epilepsy (TLE) undergoing presurgical investigation who had both complex partial seizures and secondarily GTCS during video-EEG telemetry were retrospectively reviewed. Peri-ictal heart rate (HR), corrected QT interval (QTc), HR variability, and cardiac rhythm were assessed.
  
  
  RESULTS
  Twenty-five patients were included in this study. Secondarily GTCS led to higher ictal HR, persistent postictal tachycardia, and decreased postictal HR variability. Moreover, abnormal shortening of QTc occurred in 17 patients mainly during the early postictal phase and significantly more often in secondarily GTCS. Abnormal QTc prolongation occurred in 3 patients with no significant association with GTCS. Benign cardiac arrhythmias occurred in 14 patients and were independent of seizure type.
  
  
  CONCLUSIONS
  Our data suggest a substantial disturbance of autonomic function following secondarily generalized tonic-clonic seizures (GTCS) in patients with medically refractory temporal lobe epilepsy. The observed alterations could potentially facilitate sudden cardiac death and might contribute to the association of sudden unexpected death in epilepsy with GTCS.
authors.affiliation: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK. rainer.surges@googlemail.com
authors.forename: Rainer
authors.initials: R
authors.lastname: Surges
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Scott
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Walker
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000473:pathology; D004562:Electrocardiography / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012640:Seizures / Q000150:complications* / Q000473:pathology; D013610:Tachycardia / Q000209:etiology* / Q000473:pathology; D013997:Time Factors