Electrocardiografic Changes in Seizure Disorder

Background: Seizure disorders are common in infants and children. Cardiac dysrhythmias may manifest clinically as seizure disorders which, if missed, may cause serious consequences. Objective: To investigate the electrocardiogram, conduction and rhythm disturbances in a group of patients in pediatric age group clinically presenting as various types of seizures Methods: 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. Results: 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.  Conclusion: In evaluation of refractory seizure disorders in children, particularly those provoked by emotional upset, one should bear in mind the cardiac sources of seizure.