The effect of epilepsy and antiseizure medications on cardiac autonomic functions in children with epilepsy

ABSTRACT

Background

Autonomic manifestations have been frequently studied in adults with epilepsy. Here, we evaluated cardiac autonomic (ANS) functions in children with epilepsy in the interictal period and determined the risks for their dysfunctions.

Research design and methods

This study included 60 patients (boys = 25; girls = 35 age: 14.53 ± 2.54 yrs) and 25 controls. Patients were well-controlled on antiseizure medications (ASMs). The battery of testing included measuring resting heart rate (HR) and blood pressure (BP), 30:15 ratio, HR variability (HRV) response to deep breathing, Valsalva ratio and BP changes in response to standing, isometric exercise and cold.

Results

Dizziness was reported in 25%. Autonomic dysfunctions were found in 45% (n = 27). Manifestations included high frequencies of abnormal 30:15 ratio (22%), HRV responses to deep breathing (45%), Valsalava ratio (45%), and BP responses to standing (35%), isometric exercise (27%) and cold (27%), indicating parasympathetic and sympathetic hypofunctions. There were positive correlations between parasympathetic and sympathetic dysfunctions. Logistic analysis showed that the durations of epilepsy and ASMs therapy were associated with ANS dysfunctions [95% CI: 0.895–4.719, p = 0.004].

Conclusions

Parasympathetic and sympathetic autonomic hypofunctions are common in children with epilepsy. This could be due to the depressant effect of sodium channel blocker ASMs on central and/or cardiac autonomic systems.

KEYWORDS:

• Epilepsy
• partial epilepsy
• generalized tonic clonic (GTC) seizures
• antiseizure medications (ASMs)
• autonomic nervous system (ANS) function

Abbreviations

ASMs, Antiseizure medications; CAN, central autonomic network; HRV, heart rate variability; BP, blood pressure; ANS: Autonomic nervous system; SUDEP, sudden unexpected death in epilepsy; ECG, electrocardiogram; EEG: Electroencephalography; SBP, systolic blood pressure; DBP, diastolic blood pressure; OH; orthostatic hypotension; POTs; positional orthostatic tachycardia syndrome; GTC, generalized tonic-clonic; FLE, frontal lobe epilepsy; TLE, temporal lobe epilepsy; SDNN standard deviation of all normal RR intervals in the entire 24 hours ECG recording; PNN50, percent of difference between adjacent normal RR intervals that are greater than 50 msec; RMSSD, Root mean square successive difference; LF, low frequency; HF, high frequency; VLF, very low frequency.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution

All authors (SA Hamed, AF El-Hadad and M A Aldawy) have substantially contributed to the conception and design of the article and interpreting the relevant literature and been involved in writing the article and revised it for intellectual contents. SA Hamed has drafted the manuscript. AF El-Hadad and MA Aldawy have substantially critically reviewed the article. All authors have agreed on the journal to which the article was submitted. All authors have reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage. All authors agreed to take responsibility and be accountable for the contents of the article and to share responsibility to resolve any questions raised about the accuracy or integrity of the published work.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17512433.2024.2318469

Additional information

Funding

This paper was not funded.