Impairment of Cardiac Autonomic Nerve Function in Pre-school Children With Intractable Epilepsy.

Zhao Yang,Yuxing Gao,Yuwu Jiang,Jin Deng,Shaoping Huang,Baomin Li,Feng Gao,Fei Yin,Luming Li,Tung-Yang Cheng,Xi Fang,Yanhui Chen,Jianxiang Liao,Yuan Yuan,Xiaoya Qin ,Jing Liang ,Liping Zou ,Hongwei Hao ,Zhiyan Wang ,Xingtian Shu

doi:10.3389/fneur.2021.632370

Abstract

Objective: Intractable epilepsy and uncontrolled seizures could affect cardiac function and the autonomic nerve system with a negative impact on children's growth. The aim of this study was to investigate the variability and complexity of cardiac autonomic function in pre-school children with pediatric intractable epilepsy (PIE).Methods: Twenty four-hour Holter electrocardiograms (ECGs) from 93 patients and 46 healthy control subjects aged 3–6 years were analyzed by the methods of traditional heart rate variability (HRV), multiscale entropy (MSE), and Kurths–Wessel symbolization entropy (KWSE). Receiver operating characteristic (ROC) curve analysis was used to estimate the overall discrimination ability. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) models were also analyzed.Results: Pre-school children with PIE had significantly lower HRV measurements than healthy controls in time (Mean_RR, SDRR, RMSSD, pNN50) and frequency (VLF, LF, HF, LF/HF, TP) domains. For the MSE analysis, area 1_5 in awake state was lower, and areas 6_15 and 6_20 in sleep state were higher in PIE with a significant statistical difference. KWSE in the PIE group was also inferior to that in healthy controls. In ROC curve analysis, pNN50 had the greatest discriminatory power for PIE. Based on both NRI and IDI models, the combination of MSE indices (wake: area1_5 and sleep: area6_20) and KWSE (m = 2, τ = 1, α = 0.16) with traditional HRV measures had greater discriminatory power than any of the single HRV measures.Significance: Impaired HRV and complexity were found in pre-school children with PIE. HRV, MSE, and KWSE could discriminate patients with PIE from subjects with normal cardiac complexity. These findings suggested that the MSE and KWSE methods may be helpful for assessing and understanding heart rate dynamics in younger children with epilepsy.

Highlights

Epilepsy is a brain disorder affecting patients of all ages [1] with approximately 10.5 million children in the world suffering from uncontrolled seizures [1, 2], and 20–30% of these children are resistant to antiepileptic drugs (AEDs) and other clinical therapies [3]
We looked into the difference of HRV and multiscale entropy (MSE) features between adult patients with intractable epilepsy and healthy controls [37]
Demographic data, including gender, age, and body mass index (BMI), showed no significant differences between patients and controls

Summary

Introduction

Epilepsy is a brain disorder affecting patients of all ages [1] with approximately 10.5 million children in the world suffering from uncontrolled seizures [1, 2], and 20–30% of these children are resistant to antiepileptic drugs (AEDs) and other clinical therapies [3]. Apart from recurrent and unprovoked seizures, epilepsy contributes to alterations of cardiac autonomic modulation, exhibiting an impairment of sympathetic and/or parasympathetic modulation of cardiac activity [14, 15]. Children with intractable epilepsy demonstrate age-related seizure expression [2]; more attention should be paid to younger children, especially preschool children, for their better future development. Few studies have focused on the cardiac autonomic nerve system (CANS) of pre-school children with intractable epilepsy, and whether epilepsy and seizures impair the function of CANS in such younger age range is still unknown

Methods

Results

Conclusion