Early post‐convulsive prolongation of QT time in children

Kändler, Liane; Fiedler, A.; Scheer, Katrin; Wild, F.; Frick, Ulrich; Schneider, P. M.

doi:10.1111/j.1651-2227.2005.tb02083.x

Cited by 30 publications

(24 citation statements)

References 32 publications

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“…20 Alterations of cardiac repolarization are established predictors of sudden cardiac death, 5,21 and we and others have shown abnormal QTc lengthening with seizures. 4,22 Abnormal QT prolongation was found in 6% of the seizures and 12% of the patients, thus relatively similar to the observed prevalence in our previous study. 4 Prolonged QTc interval is an established risk factor for life-threatening "Torsade de Pointes" tachy- cardia.…”

Section: Methodssupporting

confidence: 76%

Enhanced QT shortening and persistent tachycardia after generalized seizures

Surges¹,

Scott²,

Walker³

2010

Neurology

139

111

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Objective: Generalized tonic-clonic seizures (GTCS) are a major risk factor for sudden unexpected death in epilepsy (SUDEP). We investigated whether ictal/postictal cardiac features were dependent on seizure type within individual patients.Methods: ECG data from patients with medically refractory temporal lobe epilepsy (TLE) undergoing presurgical investigation who had both complex partial seizures and secondarily GTCS during video-EEG telemetry were retrospectively reviewed. Peri-ictal heart rate (HR), corrected QT interval (QTc), HR variability, and cardiac rhythm were assessed.Results: Twenty-five patients were included in this study. Secondarily GTCS led to higher ictal HR, persistent postictal tachycardia, and decreased postictal HR variability. Moreover, abnormal shortening of QTc occurred in 17 patients mainly during the early postictal phase and significantly more often in secondarily GTCS. Abnormal QTc prolongation occurred in 3 patients with no significant association with GTCS. Benign cardiac arrhythmias occurred in 14 patients and were independent of seizure type. Conclusions:Our data suggest a substantial disturbance of autonomic function following secondarily generalized tonic-clonic seizures (GTCS) in patients with medically refractory temporal lobe epilepsy. The observed alterations could potentially facilitate sudden cardiac death and might contribute to the association of sudden unexpected death in epilepsy with GTCS. Neurology ® 2010;74:421-426 GLOSSARY CI ϭ confidence interval; CPS ϭ complex partial seizure; GTCS ϭ generalized tonic-clonic seizures; HR ϭ heart rate; HRV ϭ HR variability; QTc ϭ corrected QT interval; SUDEP ϭ sudden unexpected death in epilepsy; TLE ϭ temporal lobe epilepsy.Sudden unexpected death in epilepsy (SUDEP) is the most frequent epilepsy-related cause of death and is particularly prevalent in patients with chronic epilepsy.1 In younger people with epilepsy (age 20 -40 years), the risk for sudden death is increased about 24-fold compared to the general population.2 Peri-ictal cardiorespiratory alterations are likely to be involved in the pathophysiology of SUDEP and include tachyarrhythmias and bradyarrhythmias as well as central or obstructive hypoventilation and neurogenic pulmonary edema.1 Since generalized tonic-clonic seizures (GTCS) are a major risk factor for SUDEP, 3,4 then determining the specific cardiac characteristics of GTCS may give us a considerable insight into the mechanisms underlying SUDEP. Abnormalities in cardiac repolarization, persistent elevations of heart rate (HR) after exercise, and a decreased HR variability (HRV) are established predictors for cardiac mortality and sudden cardiac death in other medical conditions or in healthy populations. [5][6][7] Previous studies have suggested a greater impact of GTCS on cardiac excitability than nongeneralized seizures with higher ictal heart rates in chronic epilepsy and SUDEP patients 4,[8][9][10][11] and possibly more cardiac arrhythmias following GTCS. 8,10 These studies, however, are confou...

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Section: Methodssupporting

confidence: 76%

Enhanced QT shortening and persistent tachycardia after generalized seizures

Surges¹,

Scott²,

Walker³

2010

Neurology

139

111

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“…However, we have demonstrated that there are some seizures that result in transiently prolonged QTc beyond normal limits even during self‐resolving seizures. Transient QTc prolongation (Kandler et al., 2005) occurred in 7 of 30 pediatric patients during a postconvulsive period of 2 h following generalized seizures.…”

Section: Discussionmentioning

confidence: 99%

Lengthening of corrected QT during epileptic seizures

Brotherstone

Blackhall²,

McLellan

2010

Epilepsia

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SUMMARYPurpose: To measure the corrected QT cardiac repolarization time before and during epileptic seizures. Methods: Thirty-nine video-EEG/ECG/SAO 2 (electroencephalography/electrocardiography/oxygen saturation) telemetry patients were included in this prospective study. Epileptic seizures were identified both clinically and electrographically. RR intervals and associated QT intervals were measured 5 min prior to the onset of the identified seizure. Consecutive RR and associated QT intervals were then measured from the seizure onset until the seizure had ended and the EEG had resumed its preseizure trace. Averaged RR and QT intervals over nine consecutive beats were applied to Bazett's, Hodge's, Fridericia's, and Framingham's formulas to compare the corrected QT values before and during the seizures.

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“…[8][9][10] Given that his repeat stress test at our evaluation was completely normal, it is more likely that his initial stress test was overinterpreted through the prism of contemplated LQTS. 5 Another consideration is the possibility of early postconvulsive prolongation of QT interval in children, as reported by Kandler et al 11 They investigated 30 consecutive infants and children with seizures and found that slight to moderate postconvulsive prolongation of the QT interval is common and transient in pediatric patients.…”

Section: Epilepsy Misdiagnosed As Long Qt Syndrome E137mentioning

confidence: 92%

Epilepsy Misdiagnosed as Long QT Syndrome: It Can Go Both Ways

2013

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Cardiogenic seizures are common and could be the sentinel event heralding the presence of congenital long QT syndrome (LQTS). Distinguishing a cardiogenic seizure from a neurogenic one is of the utmost importance. Herein, we present the case of a 12-year-old boy with recurrent episodes of syncope and seizures. Despite absence of QT prolongation on electrocardiogram, absence of documented arrhythmias, a negative LQTS genetic test, and recurrent episodes while on nadolol beta-blocker therapy, he was diagnosed with LQTS and implanted with an implantable cardioverter defibrillator (ICD). When syncope and seizure occurred with normal sinus rhythm documented on the ICD, he was referred to neurology, and an electroencephalogram was positive for numerous bursts of bilaterally synchronous generalized discharges. He was started on antiepileptic treatment after which his seizures resolved. His LQTS diagnosis was removed, beta-blocker therapy discontinued, and his ICD was explanted. He has been seizure-free for over 2 years.

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Early post‐convulsive prolongation of QT time in children

Abstract: Slight to moderate post-convulsive prolongation of the QT interval is not rare but transient in paediatric patients.

Cited by 30 publications

References 32 publications

Enhanced QT shortening and persistent tachycardia after generalized seizures

Enhanced QT shortening and persistent tachycardia after generalized seizures

Lengthening of corrected QT during epileptic seizures

Epilepsy Misdiagnosed as Long QT Syndrome: It Can Go Both Ways

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