الفهرس 
EpilepsyOnly 14 pages are availabe for public view
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Abstract
Epilepsy is one of the world’s oldest recognized conditions which can affect the quality of life for people with the disorder and their families particularly children. The electrical stimulation of various sites of the brain may cause cardiac rate and rhythm abnormalities. The most common types of cardiac autonomic dysfunction associated with seizures are tachyarrhythmia, bradyarrhythmia, and ECG changes.
The potential role of antiepileptic drugs in sudden unexpected death of epilepsy is not fully understood and no specific AED has been clearly associated with an increased risk of SUDEP. AEDs have various cardiac complications that might contribute to SUDEP following their sudden withdrawal, or by exerting direct effects on cardiac control. On the other hand, AEDs might prevent SUDEP by improving seizure control.
Heart rate variability before, during, and after the seizure is a useful tool for the detection of sympathetic-parasympathetic balance of autonomic nervous system and subsequently impact on the heart.
The aim of this work is to study the clinical and electrophysiological evidence for cardiac arrhythmic and alteration in the cardiac autonomic balance among pediatric patients with epilepsy induced by either epilepsy or antiepileptic drugs.
The study included 60 patients with epilepsy 32 males and 28 females had an age range of 4 to 12 years (mean 8.4 + 2.6 years) who were admitted at the Pediatric Neurology department or followed up at Outpatient Pediatric Neurology clinic, Ain Shams University. Forty age and sex-matched non epileptic subjects served as controls; 21 males and 19 females with age ranging from 4 to 13 years (mean 8.6 + 2.8 years).
Patients were divided into two groups: group I: included newly diagnosed patients not receiving AEDs (50%) and group II: idiopathic epileptic patients on regular AEDs that further subdivided into two subgroups: II-a receiving monotherapy (26.7%) and II-b receiving poly-therapy (23.3%).
All cases were subjected to detailed neurological and cardiac examinations, video-recorded EEG in order to document and categorize EEG abnormalities, Holter ECG recording for time and frequency domains of Heart rate variability( HRV), and standard ECG recording for QT corrected ( QTc),QT duration ( QTd ) , P wave amplitude and duration, PR interval, QRS duration, and other ECG changes.
Regarding ECG data of the patients: 22 patients (36.7 %) had Premature Atrial Contractions (PACs), 15 patients (25.0%) had Premature Ventricular Contrations (PVCs), 3 patients (5.0%) had one couplet, and one patient (1.7 %) had one triplet.
Our results revealed that, the mean values of all time domain measures and frequency domain measures of Heart rate variability ( HRV) Total Power & High Frequency (TP and HF) were significantly lower while, the mean values of Low frequency & low frequency / high frequency (LF and LF \ HF) were significantly higher in patients compared to their values in the control group.
Also there were significantly elevated mean values of QT corrected (QTc) and QT duration (QTd) in patients compared to their values in the control group.
Furthermore, our research found that, there was no significant difference was found between patients on different AEDs regimen regarding the mean values of both time and frequency domain measures of Heart rate variability (HRV) except for low frequency / high frequency (LF \ HF) values and patients on poly-therapy have insignificantly higher mean values of time domain Heart rate variability (HRV) than other groups.
Again, the mean values of Standard deviation of all normal RR intervals in the entire 24-h ECG recording (SDNN), Standard deviation of averaged normal sinus RR intervals for all 5-minutes segments of entire recording (SDANN). Mean of standard deviations of all normal RR intervals for all 5 minutes segments of the entire recording( SDNNI), and Percentage of difference between adjacent normal RR intervals that are greater than 50 ms computed over the entire 24-h ECG recording (pNN50) were significantly higher, the mean values of Total power (TP) were significantly lower, and the mean values of Chalfont severity score, QT corrected ( QTc), and QT duration (QTd) were insignificantly higher in EEG abnormality grade two (G - II). While the mean values of high frequency (HF) and low frequency/high frequency (LF\HF) were significantly lower in EEG abnormality grade three (G - III).
This research also demonstrated that, patients on mono-therapy have significant higher percentage of prolonged QRS duration, prolonged, QT corrected (QTc) and QT duration (QTd) when compared to other groups.
Lastly, we found no significant correlation between Chalfont severity score and the following: ECG parameters, frequency domains, and time domains of Heart rate variability (HRV) except for and Percentage of difference between adjacent normal RR intervals that are greater than 50 ms computed over the entire 24-h ECG recording (pNN50) of the patients.