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Children with refractory epilepsy demonstrate alterations in myocardial strain
John M Schreiber1, Lowell H Frank2, Barbara L Kroner3
1Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA.
Insights
Children with refractory epilepsy show impaired myocardial mechanics, specifically reduced systolic ventricular strain, compared to healthy children. These cardiac changes were not linked to epilepsy history or medication, warranting further investigation.
Area of Science:
- Cardiology
- Neurology
- Pediatrics
Background:
- Epilepsy is a neurological disorder that can affect multiple organ systems.
- Myocardial mechanics in children with epilepsy are not well understood.
- Refractory epilepsy may be associated with cardiac dysfunction.
Purpose of the Study:
- To investigate myocardial mechanics in children with refractory epilepsy.
- To compare cardiac function between children with epilepsy and healthy controls.
Main Methods:
- Echocardiography with speckle tracking was used to assess longitudinal and circumferential strain in 41 children with refractory epilepsy and matched controls.
- Parental surveys and chart reviews collected data on seizure history, cardiac risk factors, and antiepileptic drug use.
- Conventional echocardiographic measurements and tissue Doppler imaging were also performed.
Main Results:
- Children with epilepsy exhibited impaired longitudinal and circumferential strain, indicating reduced myocardial deformation.
- Shortening fraction was higher, while mitral valve E wave inflow velocity and tissue Doppler lateral E' wave were decreased in patients compared to controls.
- No significant differences were found in ejection fraction or associations between cardiac measurements and epilepsy characteristics.
Conclusions:
- Children with refractory epilepsy have impaired systolic ventricular strain compared to controls.
- These myocardial mechanical changes are not correlated with epilepsy history or antiepileptic drug exposure.
- Further research is necessary to elucidate the clinical significance of these findings.
Objective:
To test whether children with epilepsy have impairments in myocardial mechanics compared to controls without epilepsy.
Methods:
Children with refractory epilepsy with epilepsy duration of at least 3 years underwent echocardiography including conventional measurements and speckle tracking to assess longitudinal and circumferential strain. Parent-completed surveys, capturing critical aspects of the children's seizure history and cardiac risk factors, complemented retrospective chart reviews, which also included antiepileptic drug history. Normal echocardiograms from controls, matched for age and gender, were obtained from our institutional database and evaluated for strain.
Results:
Forty-one patients (median age = 10 years, interquartile range [IQR] = 5-15; 58.5% male) were enrolled. Epilepsy etiology included genetic (n = 26), structural (n = 6), genetic and structural (n = 5), infection (n = 3), and unknown (n = 1). No cardiac structural abnormalities were identified. Both longitudinal and circumferential strain were impaired (P < .03) in patients compared to controls (median [IQR] = 22.7% [21.2-24.2] vs 23.6% [22.2-26.1] and 22.0% [20.3-25.4] vs 24.5% [22.3-27.0], respectively), indicating decreased myocardial deformation/contraction. Shortening fraction was higher in patients (37.6% [35.7-39.7] vs 34.9% [32.5-38.7], P = .009); mitral valve E wave inflow velocity (84.8 cm/s [78.4-92.8] vs 97.2 cm/s [85.9-105.8], P = .005) and tissue Doppler lateral E' wave (13.9 cm/s [12.3-16.1] vs 17.3 cm/s [15.4-18.5], P < .001) were decreased compared to controls. Findings were similar in the pairs with epilepsy patients distinguished by the ability to independently ambulate. There was no difference between patients and controls in ejection fraction. Among the epilepsy patients, there were no associations between cardiac measurements and epilepsy characteristics, including seizure type and frequency and cardiotoxic antiseizure medication exposure after correction for multiple comparisons.
Significance:
Children with refractory epilepsy had impaired systolic ventricular strain compared to controls, not correlated with epilepsy history. Further studies are needed to determine the significance of these changes.
