The effect of epilepsy and antiseizure medications on cardiac autonomic functions in children with epilepsy

Autonomic manifestations have been frequently studied in adults with epilepsy. Here, we evaluated cardiac autonomic (ANS) functions in children with epilepsy in the interictal period and determined the risks for their dysfunctions. This study included 60 patients (boys = 25; girls = 35 age: 14.53 ± 2.54 yrs) and 25 controls. Patients were well-controlled on antiseizure medications (ASMs). The battery of testing included measuring resting heart rate (HR) and blood pressure (BP), 30:15 ratio, HR variability (HRV) response to deep breathing, Valsalva ratio and BP changes in response to standing, isometric exercise and cold. Dizziness was reported in 25%. Autonomic dysfunctions were found in 45% (<i>n</i> = 27). Manifestations included high frequencies of abnormal 30:15 ratio (22%), HRV responses to deep breathing (45%), Valsalava ratio (45%), and BP responses to standing (35%), isometric exercise (27%) and cold (27%), indicating parasympathetic and sympathetic hypofunctions. There were positive correlations between parasympathetic and sympathetic dysfunctions. Logistic analysis showed that the durations of epilepsy and ASMs therapy were associated with ANS dysfunctions [95% CI: 0.895–4.719, <i>p</i> = 0.004]. Parasympathetic and sympathetic autonomic hypofunctions are common in children with epilepsy. This could be due to the depressant effect of sodium channel blocker ASMs on central and/or cardiac autonomic systems.

成人癫痫患者的自主神经表现已得到广泛研究。本研究针对发作间期癫痫儿童的心脏自主神经（autonomic nervous system, ANS）功能展开评估，并明确其自主神经功能障碍的相关风险因素。本研究共纳入60例癫痫患者（男25例，女35例，年龄14.53±2.54岁）与25名健康对照受试者。所有入组患者均接受了可有效控制病情的抗癫痫药物（antiseizure medications, ASMs）治疗。本次检测套餐涵盖静息心率（heart rate, HR）与血压（blood pressure, BP）测量、30:15比值测定、深呼吸诱发的心率变异性（heart rate variability, HRV）反应检测、瓦尔萨尔瓦比值测定，以及站立、等长运动与冷刺激诱发的血压变化检测。共有25%的受试者报告出现头晕症状。本研究共检出45%（n=27）的患者存在自主神经功能障碍，具体异常表现包括：30:15比值异常（22%）、深呼吸诱发的HRV反应异常（45%）、瓦尔萨尔瓦比值异常（45%），以及站立（35%）、等长运动（27%）与冷刺激（27%）诱发的血压反应异常，上述结果提示存在副交感与交感神经功能低下。副交感神经与交感神经功能障碍之间呈正相关关系。Logistic回归分析结果显示，癫痫病程与抗癫痫药物治疗时长与自主神经功能障碍显著相关[95%置信区间（confidence interval, CI）：0.895–4.719，p=0.004]。副交感与交感神经自主功能低下在癫痫儿童群体中较为常见，该现象可能与钠通道阻滞剂类抗癫痫药物对中枢及/或心脏自主神经系统的抑制作用相关。