Epilepsy is associated with ventricular alterations following convulsive status epilepticus in children
Wail Ali1, Beth A Bubolz2, Linh Nguyen3
1Section of Pediatric Critical Care Medicine, Department of Pediatrics, West Virginia University, Morgantown, WV.
Insights
Convulsive status epilepticus can harm children's heart electrical properties, particularly in those with epilepsy. This suggests a need for cardiac monitoring after seizures in this vulnerable pediatric group.
Area of Science:
- Pediatric Cardiology
- Neurology
- Critical Care Medicine
Background:
- Convulsive status epilepticus (CSE) causes cardiovascular issues in adults, but its impact on pediatric ventricular electrical properties is unclear.
- Understanding these effects is crucial for managing CSE in children.
Purpose of the Study:
- To characterize ventricular electrical alterations following CSE in children.
- To identify clinical factors associated with these ECG abnormalities.
Main Methods:
- A 2-year retrospective case-control study included children (1 month-21 years) with CSE admitted to the PICU.
- Electrocardiograms (ECGs) were analyzed for ventricular abnormalities (ST changes, T wave, QRS axis, QTc interval).
- Exclusion criteria included heart disease, ion channelopathy, or vasoactive medications; age-matched controls had no seizure history.
Main Results:
- Children with CSE showed significantly higher rates of abnormal ECGs compared to controls (OR 3.8-7.0).
- Children with epilepsy had impaired QT interval adaptation to heart rate and increased beat-to-beat QTc variability, indicating repolarization instability.
- These findings highlight electrical vulnerability in pediatric CSE patients, especially those with epilepsy.
Conclusions:
- CSE adversely affects ventricular electrical properties and stability in children, with heightened risk in those with epilepsy.
- Children with epilepsy appear particularly susceptible to seizure-induced arrhythmias.
- Postictal cardiac surveillance is recommended for pediatric CSE patients, especially those with epilepsy.
Objective:
Convulsive status epilepticus can exert profound cardiovascular effects in adults including ventricular depolarization-repolarization abnormalities. Whether status epilepticus adversely affects ventricular electrical properties in children is less understood. Therefore, we sought to characterize ventricular alterations and the associated clinical factors in children following convulsive status epilepticus.
Methods:
We conducted a 2-year retrospective, case-control study. Children between 1 month and 21 years of age were included if they were admitted to the pediatric intensive care unit with primary diagnosis of convulsive status epilepticus and had 12-lead electrocardiogram (ECG) within 24 hours of admission. Children with heart disease, ion channelopathy, or on vasoactive medications were excluded. Age-matched control subjects had no history of seizures or epilepsy. The primary outcome was ventricular abnormalities represented by ST segment changes, abnormal T wave, QRS axis deviation, and corrected QT (QTc) interval prolongation. The secondary outcomes included QT/RR relationship, beat-to-beat QTc interval variability, ECG interval measurement between groups, and clinical factors associated with ECG abnormalities.
Results:
Of 317 eligible children, 59 met the inclusion criteria. History of epilepsy was present in 31 children (epileptic) and absent in 28 children (non-epileptic). Compared with the control subjects (n = 31), the status epilepticus groups were more likely to have an abnormal ECG with overall odds ratio of 3.8 and 7.0 for the non-epileptic and the epileptic groups respectively. Simple linear regression analysis demonstrated that children with epilepsy exhibited impaired dependence and adaptation of the QT interval on heart rate. Beat-to-beat QTc interval variability, a marker of ventricular repolarization instability, was increased in children with epilepsy.
Significance:
Convulsive status epilepticus can adversely affect ventricular electrical properties and stability in children, especially those with epilepsy. These findings suggest that children with epilepsy may be particularly vulnerable to seizure-induced arrhythmias. Therefore postictal cardiac surveillance may be warranted in this population.
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