Autonomic dysregulation in children with epilepsy with postictal generalized EEG suppression following generalized convulsive seizures.
Epilepsy Behav
; 102: 106688, 2020 01.
Article
en En
| MEDLINE
| ID: mdl-31805503
ABSTRACT
OBJECTIVE:
Postictal generalized electroencephalographic suppression (PGES) has been associated with sudden unexpected death in epilepsy (SUDEP) in adults. Decreased heart rate variability (HRV) is one clinical marker of SUDEP in adults with epilepsy. The objective of this study was to analyze the characteristics of HRV associated with generalized convulsive seizures (GCS)⯱â¯PGES in children.METHODS:
Nine hundred and seventy-seven consecutive children who underwent prolonged scalp video-EEG (vEEG) and 1-lead electrocardiogram (ECG) monitoring at the Hospital for Sick Children, Toronto, Ontario, Canada were reviewed retrospectively from 2009 to 2011. Thirty-five children had GCS captured during their vEEG with or without PGES and met inclusion criteria. Children were subdivided into three age groups and compared with age-matched controls 3-6â¯years; 7-12â¯years; and 13-18â¯years. Interictal HRV was measured at 5â¯min during N2 sleep. Preictal HRV was measured at 1â¯h prior to GCS onset, and postictal HRV was measured at 3â¯min post-GCS cessation. Low frequency (LF ms2, 0.04-0.15â¯Hz) and high frequency (HF ms2, 0.15-0.4â¯Hz) bands of heart rate oscillations were analyzed during the interictal and preictal periods. The root mean square of successive differences (RMSSDs) was analyzed during the following time points interictal; preictal; and postictal.RESULTS:
Thirty-five children had GCS 18 children with PGES [3-6â¯years (nâ¯=â¯2); 7-12â¯years (nâ¯=â¯6); 13-18â¯years (nâ¯=â¯10)] and 17 children without PGES [3-6â¯years (nâ¯=â¯6); 7-12â¯years (nâ¯=â¯5); 13-18â¯years (nâ¯=â¯6)]. Seventeen additional age-matched controls were identified [3-6â¯years (nâ¯=â¯3); 7-12â¯years (nâ¯=â¯5); 13-18â¯years (nâ¯=â¯9)]. Seventy-four GCS were captured consisting of 36 GCSâ¯+â¯PGES and 38 GCSâ¯-â¯PGES. There was no difference of interictal HRV among children with GCS⯱â¯PGES and controls. The preictal LF and HF in 36 GCSâ¯+â¯PGES were significantly higher compared with 38 GCSâ¯-â¯PGES (pâ¯<â¯0.01). The postictal RMSSD in 36 GCSâ¯+â¯PGES was significantly higher compared with 38 GCSâ¯-â¯PGES (pâ¯<â¯0.01). The pre- to postictal RMSSD change was significantly lower in children with GCSâ¯+â¯PGES than in those with GCSâ¯-â¯PGES (pâ¯=â¯0.035).CONCLUSIONS:
In summary, the preictal HRV in GCSâ¯+â¯PGES was significantly higher than in children with GCSâ¯-â¯PGES. The higher remaining postictal RMSSD in children with GCSâ¯+â¯PGES is a potential indicator of autonomic dysregulation. In certain children with epilepsy, autonomic dysregulation may contribute to poor recovery from a GCS with subsequent PGES, thereby contributing to SUDEP. Heart rate variability and autonomic regulation in children with epilepsy should be further studied prospectively in order to better understand the mechanism by which PGES may lead to SUDEP.Palabras clave
Texto completo:
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Banco de datos:
MEDLINE
Asunto principal:
Convulsiones
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Epilepsia Generalizada
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Electroencefalografía
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Muerte Súbita e Inesperada en la Epilepsia
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Frecuencia Cardíaca
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Child
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Female
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Humans
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Male
País/Región como asunto:
America do norte
Idioma:
En
Año:
2020
Tipo del documento:
Article