Subclinical cardiac dysfunction detected by speckle-tracking echocardiography in children with drug-resistant epilepsy

Background Pediatric epilepsy may adversely affect cardiac function. This study examined cardiac outcomes in children with controlled and drug-resistant epilepsy (DRE). Methods Sixty children with epilepsy (30 DRE, 30 drug-responsive) and 30 healthy controls underwent 12-lead ECG, M-mode echocardiography, and speckle tracking echocardiography (STE) to assess cardiac electrical activity, left ventricular (LV) volumes, ejection fraction (EF), fractional shortening (FS), and global longitudinal strain (GLS). Results ECG findings were comparable among the three groups. LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), FS, and EF were significantly lower in DRE vs. controls ( p < 0.05). LVEDV and EF were significantly lower in DRE vs. drug-responsive epilepsy ( p < 0.05), while drug-responsive cases had lower LVEDV vs. controls ( p = 0.015). LV GLS was significantly lower in DRE (−19.34 ± 1.80) vs. drug-responsive epilepsy (−20.33 ± 1.45) ( p = 0.023) and controls (−20.58 ± 0.91) ( p = 0.003). LV GLS correlated positively with time since last seizure ( p = 0.007) and negatively with the number of antiseizure medications ( p = 0.007). Conclusions Children with DRE exhibit significant cardiac dysfunction. STE enables early detection of subclinical cardiac abnormalities in DRE, advocating for its integration into routine monitoring. Impact Compares cardiac function in pediatric drug-resistant epilepsy (DRE) and drug-responsive epilepsy, identifying impaired systolic function and global longitudinal strain (GLS) in DRE. Correlates GLS abnormalities with antiseizure medication burden and time since last seizure, linking cardiac dysfunction to treatment intensity and epilepsy disease course. Advocates STE for early cardiac monitoring in DRE and urges longitudinal studies to disentangle epilepsy-related cardiovascular risks from drug-driven effects.