Kishk Nirmeen A, Sharaf Yasser, Ebraheim Asmaa M, Baghdady Yasser, Alieldin Nelly, Afify Ahmed, Eldamaty Ahmed
Neurology Department, Faculty of Medicine, Cairo University, Egypt.
Cardiology Department, Faculty of Medicine, Cairo University, Egypt.
Epilepsy Behav. 2018 Feb;79:106-111. doi: 10.1016/j.yebeh.2017.10.028. Epub 2017 Dec 20.
The occurrence of cardiac electrical abnormalities such as repolarization disorders in patients with epilepsy was previously documented and may, in part, clarify the mechanism of sudden unexpected death in those patients. The aim of this study was to investigate the frequency of cardiac repolarization disorders among patients with epilepsy and whether specific demographic- or disease-related features were associated with their occurrence.
This cross-sectional study was carried out on 1000 subjects with epilepsy who were compared with age- and sex-matched 2500 subjects without epilepsy. Clinical assessment, which included careful history taking and examination, was carried out for all participants in addition to resting 12-lead electrocardiogram (ECG) recording. Electrocardiograms were reviewed by experienced cardiologists. Electrocardiogram intervals were measured, and morphological abnormalities were identified using standard guidelines.
Repolarization abnormalities were found in 142 (14.2%) patients with epilepsy. A statistically significant elevation in percentage of corrected QT interval (QTc) prolongation (both severe and borderline) among patients with epilepsy compared with controls was documented (8.4% vs 2%, P<0.001). Epilepsy increased the likelihood of hosting prolonged QTc more than 4 times (95% confidence interval: 3.175-6.515; odds ratio: 4.548; P<0.001). Affected patients were significantly older (95% confidence interval: 1.012-1.044; odds ratio: 1.027; P=0.001), and the abnormality was significantly more prevalent among those with poor seizure control (95% confidence interval: 1.103-2.966; odds ratio: 1.809; P=0.019). On the other hand, early repolarization (ER) pattern and Brugada type ECG pattern (BP) were significantly more prevalent in subjects without epilepsy.
Corrected QT interval prolongation (both severe and borderline) was more prevalent among patients with epilepsy, especially if uncontrolled or elderly. Electrocardiogram should be established as a part of the diagnostic workup of epilepsy in order to identify such electrocardiographic abnormality.
癫痫患者中心脏电异常如复极障碍的发生此前已有记载，这可能部分阐明了这些患者突然意外死亡的机制。本研究的目的是调查癫痫患者中心脏复极障碍的发生率，以及特定的人口统计学或疾病相关特征是否与其发生有关。
本横断面研究对1000例癫痫患者进行了研究，并与年龄和性别匹配的2500例无癫痫患者进行了比较。除静息12导联心电图（ECG）记录外，对所有参与者进行了临床评估，包括仔细的病史采集和检查。心电图由经验丰富的心脏病专家进行审查。测量心电图间期，并使用标准指南识别形态学异常。
在142例（14.2%）癫痫患者中发现复极异常。与对照组相比，癫痫患者中校正QT间期（QTc）延长（严重和临界）的百分比有统计学意义的升高（8.4%对2%，P<0.001）。癫痫使QTc延长的可能性增加了4倍多（95%置信区间：3.175 - 6.515；比值比：4.548；P<0.001）。受影响的患者年龄显著更大（95%置信区间：1.012 - 1.044；比值比：1.027；P = 0.001），并且该异常在癫痫控制不佳的患者中显著更常见（95%置信区间：1.103 - 2.966；比值比：1.809；P = 0.019）。另一方面，早期复极（ER）模式和Brugada型心电图模式（BP）在无癫痫患者中显著更常见。
校正QT间期延长（严重和临界）在癫痫患者中更常见，尤其是在未得到控制或老年患者中。应将心电图作为癫痫诊断检查的一部分，以识别此类心电图异常。
