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Measuring Cardiac Autonomic Nervous System (ANS) Activity in Children
Published on: April 29, 2013
Non-invasive assessment of cardioregulatory autonomic functions in children with epilepsy
H L El-Sayed1, A A Kotby, H Y Tomoum
1Department of Pediatrics, Faculty of Medicine, Ain Shams University, 10 El-Nagah Street, El-Nozha, Cairo 11361, Egypt.
Insights
Pediatric patients with epilepsy frequently experience cardiac autonomic dysfunction, impacting cardiovascular regulation. This dysfunction appears linked to epilepsy itself, not specific epilepsy characteristics.
Area of Science:
- Cardiology
- Neurology
- Autonomic Nervous System Research
Background:
- Idiopathic epilepsy affects pediatric populations, with potential implications for cardiovascular health.
- Cardiovascular autonomic function in children with epilepsy requires thorough investigation.
Purpose of the Study:
- To assess interictal cardiovascular autonomic functions in pediatric patients diagnosed with idiopathic epilepsy.
- To compare autonomic function between epileptic children and healthy controls.
Main Methods:
- Utilized five clinical cardiovascular autonomic reflex tests and 12-lead electrocardiography.
- Performed 24-hour Holter monitoring to analyze heart rate variability (HRV) time-domain parameters (SDNN, PNN50, rMSDD).
- Measured urinary vanillyl mandelic acid and metanephrine levels; assessed autonomic dysfunction severity and correlation with epilepsy control.
Main Results:
- Significant prevalence of autonomic dysfunction observed: 8% mild, 44% moderate, 4% severe.
- Reduced HRV parameter SDNN across all age groups; rMSDD and PNN50 decreased in older children.
- Lower metanephrine levels in patients; uncontrolled epilepsy correlated with higher autonomic dysfunction frequency.
Conclusions:
- Cardiac autonomic dysfunction is a common comorbidity in pediatric epilepsy.
- Evidence suggests epilepsy itself, rather than its specific traits, underlies altered cardiovascular regulation.
Objectives:
We aimed to evaluate the interictal cardiovascular autonomic functions in pediatric patients with idiopathic epilepsy, both partial and generalized.
Materials And Methods:
The study included 25 patients with idiopathic epilepsy and 50 control subjects. Patients underwent five standardized clinical cardiovascular reflex autonomic tests [resting heart rate (HR), HR response to deep breathing and to Valsalva maneuver, the 30:15 ratio of HR response to standing, and blood pressure response to standing], as well as a 12 lead surface electrocardiogram. Heart rate variability (HRV) was tested via 24-h Holter monitoring and the time domain parameters (SDNN, PNN50, rMSDD) were assessed. Excretion of vanillyl mandelic acid and metanephrine was measured in 24-h urine collection.
Results:
Clinical reflex autonomic tests showed mild dysfunction in 8%, moderate dysfunction in 44% and severe dysfunction in 4% of patients. The HRV parameter, SDNN, was reduced in all age groups, while rMSDD and PNN50 were reduced only in the older age group. Metanephrine levels were significantly reduced in the patients group. Patients with uncontrolled epilepsy had a significantly higher frequency of autonomic dysfunction as assessed by clinical scoring.
Conclusion:
Cardiac autonomic dysfunction is not uncommon in pediatric patients with epilepsy. Altered cardiovascular regulation seems to be related to the epilepsy itself rather than to the characteristics of the disorder.
