الفهرس 
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Abstract
Epilepsy is one of the world’s oldest recognized conditions which can affect the quality of life for people with the disorder and their families particularly children. The electrical stimulation of various sites of the brain may cause cardiac rate and rhythm abnormalities. The most common types of cardiac dysrhythmia associated with seizures are tachyarrhythmia, bradyarrhythmia, and ECG changes.
Simultaneous monitoring of ECG and other autonomic parameters during EEG recording in seizures, particularly intractable ones, should be performed to gain more insight into ictal semiology, to avoid misdiagnosis of non-epileptic attacks and disclose a potentially lethal condition ’’SUDEP’’.
The study included 20 seizure episodes recorded in 12 patients with intractable epilepsy (2 attacks of seizures were recorded in 8 patients). The patients were 8 males and 4 females with an age range of 3 to 14 years (mean 7.3 + 3.7 years) who were admitted at the Pediatric Neurology department or followed up at Outpatient Pediatric Neurology clinic, Ain Shams University. Thirty age and sex-matched non epileptic subjects served as controls. All patients were diagnosed as symptomatic epilepsy and the majority had focal (extratemporal) seizures.
All cases were subjected to detailed neurological and cardiac examinations, video-recorded EEG in order to document an ictal event simultaneously with holter ECG recording. The onset and termination of the attacks were based on EEG criteria. The holter ECG recordings were retrospectively analyzed to determine peri-ictal changes in heart rate, time domain measures of HRV, QTc, and ECG changes.
Regarding rate and rhythm abnormalities of the patients during seizures, IT occurred in 11 patients (19\20 of seizures), IB occurred in 1 patient, PACs in 2 patients (10.0% of seizures), and PVCs in 5 patients (35.0% of seizures). Both PACs and PVCs were recorded in the 1st post-ictal hour.
Our results revealed that, mean values of basal heart rate and basal HRV were significantly decreased in the case group compared to their values in the control group. Ictal tachycardia was the most prevalent cardiac change during epileptic fits as it occurred in 95% of seizures whereas ictal bradycardia was seen in only 5% of seizures.
Our results showed elevated mean values of heart rate from the basal levels (1 hr) pre-ictally, during ictal period, and still elevated (1 hr & 2 hrs) post-ictally.
Our results revealed that, mean values of SDNN, SDANN, pNN50 and rMSSD were significantly lower in the cases during the pre-ictal period compared to their basal values. The mean values of SDNN, SDANN, SDNNI, and pNN50 were significantly lower in the cases during the first post-ictal hour compared to their basal values and as well to the pre-ictal values. On the other hand, all values of HRV were significantly lower in the cases during the 2nd post-ictal hour when compared to either the basal or the pre-ictal values. The mean values of basal QTc of cases were not significantly different from their pre-ictal and post-ictal values.