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小儿癫痫猝死风险的心电图标志物:全面性发作与局灶性发作的比较研究

Electrocardiographic Markers of Sudden Unexpected Death Risk in Pediatric Epilepsy: A Comparative Study of Generalized and Focal Seizures.

作者信息

Karaca Serra, Özbingöl Doruk, Karaca Özer Pelin, Yavuz Mustafa Lütfi, Nişli Kemal, Öztarhan Kazım, Duman Kayar Çisem, Öney Ceyda, Yıldız Edibe Pempegül

机构信息

Department of Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey.

Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey.

出版信息

Diagnostics (Basel). 2025 Jun 26;15(13):1622. doi: 10.3390/diagnostics15131622.


DOI:10.3390/diagnostics15131622
PMID:40647621
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12249139/
Abstract

: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in pediatric epilepsy. Cardiac arrhythmias, possibly reflected by electrocardiographic (ECG) abnormalities, are thought to contribute significantly to SUDEP risk. This study aimed to evaluate ECG indices associated with an increased risk of both atrial and ventricular arrhythmias and sudden cardiac death in pediatric patients with generalized and focal seizures, excluding those with underlying channelopathies. : Pediatric patients aged 0-18 years with generalized or focal epilepsy followed at our center between October 2024 and April 2025 were enrolled. Comprehensive cardiac evaluations, including echocardiography and 12-lead ECG, were conducted. Patients with channelopathies, structural heart defects, or significant congenital heart disease were excluded. ECG parameters-QT dispersion (QT Disp), corrected QT interval (QTc), QTc dispersion (QTc Disp), P-wave dispersion (P Disp), and T peak-T end interval (Tp-e)-were analyzed across epilepsy subgroups and compared to healthy controls. Effects of antiepileptic drug (AED) use and gender were also assessed. : A total of 151 participants were included (generalized: = 51; focal: = 50; controls: = 50). QTc and Tp-e intervals were prolonged in both epilepsy groups compared to controls ( = 0.001 and = 0.036, respectively), however, they fell within the conventional parameters. AED use was associated with further prolongation of QTc ( = 0.035) and Tp-e ( = 0.037), these metrics were similarly found to be within the established normative boundaries. Phenobarbital and lamotrigine users showed the longest QTc, albeit not statistically significant. Males with generalized seizures had longer maximum P-wave duration (P Max) than females ( = 0.009). A moderate correlation was found between Tp-e and QTc (r = 0.557, = 0.001). : Although there are findings in our study that may suggest a relationship between SUDEP and arrhythmia according to electrocardiographic markers associated with arrhythmia risk, larger and prospective studies with long-term follow-up are needed in the future.

摘要

癫痫性猝死(SUDEP)是小儿癫痫死亡的主要原因。心律失常可能通过心电图(ECG)异常反映出来,被认为是导致SUDEP风险的重要因素。本研究旨在评估与小儿全身性和局灶性癫痫发作患者心房和心室心律失常及心源性猝死风险增加相关的心电图指标,排除那些患有潜在离子通道病的患者。 招募了2024年10月至2025年4月在我们中心随访的0至18岁患有全身性或局灶性癫痫的小儿患者。进行了全面的心脏评估,包括超声心动图和12导联心电图。排除患有离子通道病、结构性心脏缺陷或严重先天性心脏病的患者。对癫痫亚组的心电图参数——QT离散度(QT Disp)、校正QT间期(QTc)、QTc离散度(QTc Disp)、P波离散度(P Disp)和T峰-T末间期(Tp-e)进行分析,并与健康对照进行比较。还评估了抗癫痫药物(AED)使用和性别的影响。 共纳入151名参与者(全身性:n = 51;局灶性:n = 50;对照组:n = 50)。与对照组相比,两个癫痫组的QTc和Tp-e间期均延长(分别为P = 0.001和P = 0.036),然而,它们仍在传统参数范围内。使用AED与QTc(P = 0.035)和Tp-e(P = 0.037)的进一步延长相关,这些指标同样被发现处于既定的正常范围内。苯巴比妥和拉莫三嗪使用者的QTc最长,尽管无统计学意义。全身性发作的男性最大P波时限(P Max)比女性长(P = 0.009)。发现Tp-e与QTc之间存在中度相关性(r = 0.557,P = 0.001)。 尽管本研究的结果可能表明根据与心律失常风险相关的心电图标志物,SUDEP与心律失常之间存在关联,但未来需要进行更大规模的前瞻性长期随访研究。

相似文献

[1]
Electrocardiographic Markers of Sudden Unexpected Death Risk in Pediatric Epilepsy: A Comparative Study of Generalized and Focal Seizures.

Diagnostics (Basel). 2025-6-26

[2]
Sertindole for schizophrenia.

Cochrane Database Syst Rev. 2005-7-20

[3]
Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Cochrane Database Syst Rev. 2022-4-1

[4]
Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Cochrane Database Syst Rev. 2017-6-29

[5]
Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Cochrane Database Syst Rev. 2017-12-15

[6]
Incidence and Types of Cardiac Arrhythmias in the Peri-Ictal Period in Patients Having a Generalized Convulsive Seizure.

Neurology. 2024-7-9

[7]
Levetiracetam add-on for drug-resistant focal epilepsy: an updated Cochrane Review.

Cochrane Database Syst Rev. 2012-9-12

[8]
Lamotrigine versus carbamazepine monotherapy for epilepsy: an individual participant data review.

Cochrane Database Syst Rev. 2018-6-28

[9]
Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation.

Health Technol Assess. 2005-4

[10]
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Health Technol Assess. 2008-6

本文引用的文献

[1]
Epilepsy Research Institute UK Sudden Unexpected Death in Epilepsy (SUDEP) workshop: Identifying the pre-clinical and clinical priorities for SUDEP research.

Epilepsy Behav. 2025-10

[2]
Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy.

Epilepsia. 2025-6

[3]
Levetiracetam, from broad-spectrum use to precision prescription: A narrative review and expert opinion.

Seizure. 2023-4

[4]
The relationship between premature ventricular complexes and index of cardiac-electrophysiological balance.

Rev Assoc Med Bras (1992). 2023

[5]
Association between ventricular premature contraction burden and ventricular repolarization duration.

Rev Assoc Med Bras (1992). 2022

[6]
Evaluation of QT dispersion in epileptic patients and its association with SUDEP risk.

Epilepsy Res. 2022-2

[7]
Cardiac adverse effects of antiseizure medications.

Expert Opin Drug Saf. 2022-5

[8]
Autonomic Characteristics of Sudden Unexpected Death in Epilepsy in Children-A Systematic Review of Studies and Their Relevance to the Management of Epilepsy in Rett Syndrome.

Front Neurol. 2021-2-5

[9]
Cardiac arrhythmias and sudden unexpected death in epilepsy: Results of long-term monitoring.

Heart Rhythm. 2021-2

[10]
Postictal generalized EEG suppression and postictal immobility: what do we know?

Epileptic Disord. 2020-6-1

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