Semptomatik Epileptik Çocuklarda Nöbet Esnasında Görülen Elektrokardiyografik Değişiklikler

Abstract

Amaç: Epileptik nöbet esnasında meydana gelen kardiyak aritmiler epilepside ani beklenmedik ölüm (SUDEP) için bir risk faktörüdür. Bu çalışmada, epilepsili çocuklarda nöbet esnasında meydana gelen kardiyak ritim ve ileti kusurlarının tespit edilmesi amaçlanmıştır. Materyal ve metod: Bu prospektif gözlemsel çalışma, Karadeniz Teknik Üniversitesi Tıp Fakültesi, Çocuk Nöroloji Bölümü’nde epilepsi tanısı ile izlemde olup, nöbet geçirme nedeniyle hastaneye yatırılan hastalarda gerçekleştirildi. Hastalar monitörize edilerek istirahat dönemlerinde ve nöbetleri esnasında elektrokardiyografi (EKG) kayıtları alınıp, ritim ve ileti kusurları açısından incelendi. Ayrıca bu EKG’lerden kalp hızı, PR mesafesi, QT mesafesi ve düzeltilmiş QT’ler (QTc) hesaplandı. Bulgular: Yedi ay boyunca yürütülen bu çalışmaya, dahil edilme kriterlerini karşılayan 50 epilepsi hastası dahil edildi. Hastaların yaş medyanı (IQR) 8 (4,37-11,87) yıl olup 29’u (%58) kız, 21’i erkek (%42) idi. Hastalardan istirahat esnasında 50 adet ve nöbet esnasında da 157 adet EKG kayıtları elde edilip incelendi. İstirahat dönemi ile nöbet esnasındaki EKG kayıtları karşılaştırıldığında, nöbet esnasında kalp hızında (atım/dk) [93 (79,5-107); 136 (115-150), p<0,001] ve QTc süresinde (msn) [450 (415,5-481); 506 (482-538,5), p<0,001] istatistiksel olarak anlamlı artış vardı. Tüm hasta grubunda istirahatte bir hastada ST segment değişikliği (ST yükselmesi; erken repolarizasyon) varken, nöbet esnasında dört hastada ST segment çökmesi vardı. Bu fark istatistiksel anlama ulaşmadı. İstirahat esnasında hiçbir hastada aritmi gözlenmezken, nöbet esnasında bir hastada solunumsal aritmi, bir hastada supraventriküler taşikardi ve bir hastada sık ventriküler erken vurular izlendi. Sonuç: Epileptik çocuklarda nöbet sırasında en sık karşılaşılan bulgu taşikardi olup, iktal bradikardi ve asistoli daha nadir gözlenmektedir. Nöbet esnasında meydana gelen QTc uzaması, aritmi gelişmesine ve izlemde eşlik edebilecek hipoksi ile SUDEP riskinde artışa neden olabilir. Dolayısıyla nöbet esnasında ortaya çıkan kardiyak ritim ve ileti bozuklukları, SUDEP için potansiyel bir risk faktörü olup daha dikkatli yaklaşılması gerekmektedir.

Keywords

• Epilepsi
• Çocuk
• Elektrokardiyografi
• SUDEP
• Kardiyak aritmi

The Electrocardiographic Changes During Seizures in Symptomatic Epileptic Children

Abstract

Background: Cardiac arrhythmias that occur during an epileptic seizure are a risk factor for sudden unexpected death in epilepsy (SUDEP). We aimed to determine the cardiac rhythm and conduction defects during seizures in children with epilepsy. Material and Methods: This prospective observational study was conducted on patients diagnosed with epilepsy and followed up in Karadeniz Technical University Faculty of Medicine, Department of Pediatric Neurology, who were hospitalized due to seizures. The patients were monitored and electrocardiography (ECG) were taken during their rests and seizures. These were analyzed for rhythm and conduction defects. Also, heart rate, PR distance, QT distance, and corrected QTs (QTc) were calculated. Results: This study, conducted over seven months, included 50 epilepsy patients who fulfilled the inclusion criteria. The median age of the patients (IQR) was 8 (4.37-11.87) years, 29 (58%) were female and 21 (42%) were male. 50 ECG recordings were obtained from the patients during rest and 157 during seizures and were investigated. When the ECGs of the rests and seizures were compared, there was statistically significant increase in heart rate (beats/min) [93 (79.5-107); 136 (115-150), p<0.001] and QTc duration (ms) [450 (415.5-481); 506 (482-538.5), p<0.001]. One patient had ST-segment change (ST-elevation; early repolarization) at rest, while four patients had ST-segment depression during seizures. This difference did not reach statistical significance. While arrhythmia was not observed in any patient during rest, during the seizure, one patient had respiratory arrhythmia, one patient had supraventricular tachycardia, and one patient had frequent ventricular premature beats. Conclusions: The most common finding during seizures in children with epilepsy is tachycardia, while ictal bradycardia and asystole are less common. QTc prolongation occurring during a seizure can lead to arrhythmias and, with accompanying hypoxia during follow-up, increase the risk of SUDEP. Therefore, cardiac rhythm and conduction abnormalities occurring during a seizure are potential risk factors for SUDEP and should be approached with caution.

Keywords

• Epilepsy
• Child
• Electrocardiography
• SUDEP
• Cardiac arrhythmia

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