Effect of Intractable Epilepsy on the Physiological Cardiac Performance Parameters and the Serum Levels of Cardiac Fatty Acid Binding Protein in Pediatrics

Abstract
Background: Multiple cardiac changes and various abnor-malities have been linked to epileptic fits. The assessment of cardiac changes and serum biomarkers level are commonly accepted methods to evaluate autonomic disturbances during epileptic fits which is very closely associated with some cardiovascular events especially the sudden unexpected cardiac death.
Aim of Study: To evaluate ictal and inter-ictal cardiac changes and plasma levels of heart type fatty acid binding protein (H-FABP) in pediatric patients with treatment resistant epilepsy.
Patients and Methods: 32 seizure attacks were recorded in 23 children with intractable seizures. Simultaneous Holter-ECG and video-EEG recordings were done with evaluation of changes in Heart Rate (HR), parameters of Heart Rate Variability (HRV), as well as serum levels of H-FABP as a marker of myocardial ischemia in the ictal and inter-ictal periods and compared with a control group.
Results: The recorded HR changes included Ictal Tachy-cardia (IT) (96.87%), Ictal Bradycardia (IB) (3.13%), Prema-ture Atrial Contractions (PAC) (18.75%) and Premature Ventricular Contractions (PVC) (28.13%) in the first post-ictal hour. Significant HR increase was observed in the pre-ictal hour and ictal values compared to basal values and remained high 2 hours post-ictally. Basal HR and serum levels of the H-FABP protein were significantly higher while time domain HRV parameters were significantly lower in the patients compared to controls.
Conclusion: Significant cardiac changes may occur even before the seizure onset in cases with intractable epilepsy. The increased levels of H-FABP may indicate the presence of autonomic instability and myocardial ischemia even in asymptomatic patients.