Change of heart rate variability in children and adolescent with drug resistant epilepsy

Abstract

Heart rate variability (HRV) has been examined and employed as a predictive biomarker for epilepsy. Patients with epilepsy exhibit reduced HRV as a result of heightened sympathetic activity. Reductions in HRV are observed in patients with sudden unexpected death in epilepsy (SUDEP). Our study aims to determine the change in HRV among children and adolescents with drug-resistant epilepsy (DRE) and advocate for its use as a biomarker to assess cardiovascular health in this population. Fifty-four children and adolescents, aged between 6 and 20 years, were enrolled and divided into two groups: the epilepsy group comprised 27 children diagnosed with DRE. Thirty minutes of HRV measurements were performed on both patients and controls. The median age was 12 years old. Malnutrition was the most common comorbidity in the epilepsy group. 75% have been diagnosed with DRE for more than 10 years. 44% had daily seizures. Generalized tonic-clonic seizures (GTCs) were the most common seizure type, accounting for 55.6% of cases. The most frequent cause of epilepsy was structural brain lesions (55.6%), followed by genetic disorders (18.5%). Patients with DRE had a significant reduction in both HRV's time domain (RMSSD and pNN50) and frequency domain (HF and LF). Patients who had GTC and had epilepsy for more than 10 years had a significant reduction in the low-frequency domain of HRV, according to the subgroup analysis. Children and adolescents with DRE exhibited a marked decrease in HRV measures, thereby increasing the likelihood of cardiovascular health issues in these patients. HRV can be used as a biomarker to effectively assess cardiovascular health in DRE patients.

Keywords: Biomarkers; Drug-resistant epilepsy; HRV; Heart rate variability; SUDEP.