Electrocardiografic Changes in Seizure Disorder

Seizure disorders are common in infants and children. Cardiac dysrhythmias may manifest clinically as seizure disorders which, if missed, may cause serious consequences. To investigate the electrocardiogram, conduction and rhythm disturbances in a group of patients in pediatric age group clinically presenting as various types of seizures We studied electrocardiograms of 273 infants and children aged 5 months to 16 years who presented with febrile and afebrile seizures. Of these, 155 (56.8%) were male and 118 (43.2%) were female (M/F= 1.3). Most of the patients (n=230, 84.2%) presented with generalized tonic-colonic seizures. Beside neurological evaluation, a thorough cardiac investigation including auscultation, electrocardiogram, and when indicated, echocardiography, exercise tolerance test, and 24-hour heart monitoring, was performed on all of these patients. Out of 273 patients, 32 (11.7%) showed either prolonged corrected QT (QTc), or other dysrhythmias. In 6 patients, the 24-hour ambulatory heart monitoring also revealed abnormalities (mostly dysrhythmias). In 9 of the above patients, the anti-arrhythmic management was instituted, depending on the results of cardiac evaluation. Precipitation of "seizure" episodes by exercise and emotional upset predicated the presence of an underlying cardiac rhythm disturbance. In evaluation of refractory seizure disorders in children, particularly those provoked by emotional upset, one should bear in mind the cardiac sources of seizure.