Electrocardiographic Changes Associated With Epilepsy

Overview

Identify and characterize electrocardiographic (ECG) changes occurring during the post-ictal phase of epileptic seizures. Evaluate the duration and severity of post-ictal ECG abnormalities. Assess the correlation between ECG changes and seizure type, duration, and severity. Explore the association of ECG changes with patient demographics

Epilepsy is a chronic disease triggered by increased impulsiveness of nerve cells in the brain and may require a lifelong treatment. Epilepsy is confirmed by two or more unprovoked seizures in more than 24 hours, Febrile Convulsion (FC) is another type of seizure occurring due to fever over 38 °C without a history of convulsion, CNS infection, electrolyte imbalance, metabolic disorder, intoxication, and trauma . Epilepsy is one of the most common neurological conditions which occurs in approximately 0.5-1% of children worldwide. However, it is not a disease entity but a syndrome of symptoms that can occur against various morphological and metabolic changes in the brain. One of the symptoms of epilepsy is epileptic seizures, i.e., temporary bioelectrical disturbances in the nerve cells of the brain . The simplified classification of epileptic seizures distinguishes between generalized seizures and partial (focal) seizures, depending, among other things, on the area of the brain where the discharges occur. Determination of the epileptic syndrome, i.e., the specific set of seizure types and electroencephalographic and imaging features, is the final stage of diagnosis . The cause of epilepsy is very often not recognized, and for this reason the diagnosis should be based on a thorough history of the patient, witnesses to the seizures, electroencephalogram (EEG) studies, and structural and functional neuroimaging of the central nervous system . One of the most dangerous changes occurs due to epileptic seizures are cardiovascular changes, which may result in sudden unexpected death in epileptic patients. Moreover, seizure leads to disturbance in cardiac functions and resulting in syncopal events, notablygeneralized convulsive seizures, put the cardiovascular system on strain, which may promote cardiac complications such as cardiac arrhythmias, cardiomyopathy, and myocardial infarction . A significant proportion of patients saw a rise in cardiac necrosis and dysfunction indicators after protracted convulsions, which might signal the beginning of myocardial damage Relevant abnormalities like prolonged QTc interval or cardiac block can be detected by a 12-lead ECG, which is an inexpensive test. Hypocalcemia as a cause of convulsions can be identified on an electrocardiogram (ECG) by a QTc prolongation due to a ST segment elongation, the severity of which is inversely related to the serum calcium level . Electrocardiographic changes in patients with drug-resistant epilepsy discovered that patients with epilepsy had significantly longer mean PR intervals, shorter mean QRS durations, shorter mean QTc intervals, and longer corrected QT interval dispersion than subjects without epilepsy . Cardiac electrical and functional abnormalities also have been described in children with epilepsy suggesting that the epileptic heart may affect pediatric patients. Implicit in the concept of the epileptic heart is that the epilepsy chronicity may be associated with an increased risk of developing cardiovascular complications. To date, only a few studies with small numbers of patients or highly selective populations have demonstrated the associations between cardiac alterations and longstanding epilepsy . ECG changes are commonly observed in epilepsy which make ECG a promising candidate to monitor seizure risk. Most ECG research in this domain has focused on heart rate-related changes. However, several studies have identified a range of other peri-ictal ECG parameter changesthat may potentially prove useful for seizure detection and forecasting.

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