Heart rate vari̇abi̇li̇ty i̇n chi̇ldhood epi̇lepsi̇

Heart rate variability (HRV) is a noninvasive method used to assess the status of autonomic function of heart. Reduced HRV in epilepsy patients may play a major role in the pathophysiology of sudden unexpected death (SUDEP) that is the commonest cause of death related to epilepsy. The goal of this prospective study was to evaluate heart rate variability in children with epilepsy. 61 epileptic children with average age = 9.15 ± 4.60 years and 53 healthy children with average age = 9.78 ± 4.05 years were included in the study. All subjects in the study were assessed by 24h Holter monitoring for HRV, electrocardiography (ECG) and echocardiography (ECO). In the epilepsy patient group compared to controls was not determined a significant difference in parameters of ECG and ECO except for shortening fraction. In the patient group was determined a significant reduction in all of the time domain (SDNN, SDNN index, SDANN, RMSSD, and pNN50) and frequency domain (LF, HF, VLF) parameters. In the patients with pathological, EEG, SDNN, SDNN index, SDANN index, LF and VLF values were detected a significant suppression when compared with patients with normal EEG. There was a significant reduction in SDNN, SDNN index, SDANN index, RMSSD, LF, HF and VLF values in the patients underwent polytherapy regimen when compared to patients underwent monotherapy regimen. In patients with refractory epilepsy, SDNN and SDANN index were significantly suppressed when compared with the values of patients with well-controlled epilepsy. The data of this study showed that suppressed HRV in the patients with epilepsy was assosiated with polytherapy, refractory epilepsy and pathological EEG. This increased sympathetic activity in association with a decreased parasympathetic tone may play a key role in the development of ventricular tachyarrhythmias in children with epilepsy and may explain the mechanism underlying SUDEP in children with epilepsy. HRV which is a noninvasive method could used to evaluate the risk of the possible fatal cardiac arrhythmia in patients with refractory epilepsy underwent polytherapy regimen.