Seizure-related autonomic changes in children

Abstract

Although sudden unexpected death in epilepsy is encountered less frequently in children versus adults, it is still an important direct epilepsy-related cause of death in this population. Just as in adults, the pathophysiology of sudden unexpected death in epilepsy in children is believed to involve seizure-related autonomic dysfunction. Seizures that develop during the pediatric period can be marked by some of the most dramatic alterations in autonomic functions seen at any age. This article reviews such seizure-related autonomic changes, including ictal nausea/emesis, hypersalivation, hypoxemia, apnea, tachycardia, bradycardia, cardiac repolarization anomalies, reduced heart rate variability, and postictal generalized EEG suppression. Understanding age-related changes in the autonomic effects of seizures and how they relate to risk of sudden death may help us to one day better elucidate the pathophysiology of sudden unexpected death in epilepsy. Given the high rate of sudden unexpected death in epilepsy in certain pediatric populations (such as those with Dravet syndrome), this knowledge is desperately needed.