Cardiac dysrhythmia in drug-resistant epileptic children

Background Drug-resistant epilepsy is one of the most common neurological conditions associated with high mortality and morbidity rates. Aim To assess heart rate variability among drug-resistant epileptic children. Patients and methods This observational cross-sectional case–control study included 60 epileptic children. Cases were assigned into two equal groups: group 1 (drug-resistant group) included children presented with drug-resistant epilepsy and group 2 (control group) included cases with controlled primary epilepsy who achieved sustained seizure freedom for at least 6 months on one antiepileptic drug, matched with the patient group regarding age and sex. All patients were subjected to history taking and clinical and radiological investigations including computed tomography (CT) and/or MRI and electroencephalogram (EEG) monitoring. ECG monitoring was using Holter ECG. Results MRI, EEG, and ECG abnormalities are significantly more common in drug-resistant epilepsy. Interictal tachycardia was the most prevalent abnormality among group I (93.3%). ECG structure was abnormal in 33.3% in group I, in the form of prolonged QTc interval, ST segment abnormalities, P wave dispersion, and T wave alternans. Tachycardia associated with prolonged QTc interval was present in patients with focal or temporal EEG abnormalities, and patients with multifocal EEG abnormalities. Conclusion ECG monitoring is important in drug-resistant epileptic children to detect any autonomic changes occurring in the heart either ictally or interictally. Heart rate is significantly higher and RR interval is significantly shorter ictally than interictally. Careful monitoring of these changes may help in predicting the risk of sudden unexpected death.