Cardiac autonomic dysfunction in West syndrome.
BACKGROUND
West syndrome is an age-dependent epileptic encephalopathy. Autonomic changes are increasingly being recognized in patients with epilepsy: cardiac autonomic function is mediated by sympathetic and parasympathetic efferent activity to the heart and can provide information on the functional state of the autonomic nervous system. The goal of the study is to evaluate the effect of an early epileptic encephalopathy on the autonomic nervous system by measuring heart rate variability.


METHODS
Cardiac autonomic function was evaluated in 13 patients with West syndrome by measuring heart rate variability during 5 min epochs of ECG in wake, stage 2 and slow wave sleep. In 5 patients who developed subsequently another type of epilepsy, a second evaluation was performed after 3 years of follow-up.


RESULTS
Results showed a lower heart rate in stage 2 sleep in patients with West syndrome. Spectral components did not show significant differences compared to age matched controls at the moment of presentation. After follow-up of 3 years we were able to demonstrate higher low frequency (LF), lower high frequency (HF) and a higher LF/HF ratio during slow wave sleep.


CONCLUSIONS
This study shows a lower heart rate in patients presenting with West syndrome, already at the onset of the syndrome and before ACTH treatment. The epileptic encephalopathy is not sufficient to alter spectral components of heart rate at the moment of presentation. However, already after 3 years of epilepsy, chronic autonomic changes appear.
Department of Pediatrics, University Hospitals Leuven, Belgium.
Katrien
K
Jansen
Steven
S
Vandeput
Sabine
S
Van Huffel
Lieven
L
Lagae
D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004562:Electrocardiography; D004569:Electroencephalography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D013036:Spasms, Infantile / Q000150:complications* / Q000188:drug therapy; D013057:Spectrum Analysis
D000927:Anticonvulsants