Power spectrum analysis of heart rate variability in children with epilepsy

Object: Children with epilepsy have been found to be at increased risk of d eath during childhood. Sudden unexpected death (SUDEP) has accounted for at least 12% of deaths of children with epilepsy. The exact mechanisms of SUD EP are unknown; however, theories suggested have, to date, focused on auton omic instability. The purpose of this study was to investigate autonomic fu nction in children with chronic epilepsy by means of power spectrum analysi s of heart rate variability. Methods: Thirty patients with epilepsy and 30 control subjects, all between the ages of 4 and 10 years, were enrolled in this study. Power spectrum analysis of heart rate variability (HRV) was per formed under standardized conditions after the patients had rested for 15 m in. Each patient was tested in a supine position first and then again in a head-up tilted position, with 15 min between the two tests. Results: There was no significant difference between the low-frequency component (LF) and the high-frequency component (HF) of heart rate variability, or the LF/HF r atio, between the study and control groups, whether the test subjects were in the supine or the head-up tilt position. In the control group, however, the subjects showed a significantly greater LF component and a smaller BF c omponent of heart rate variability, and a greater LF/RF ratio in the head-u p position than in the supine position. This implies a normal sympathovagal balance. This phenomenon was not observed in the study group. This implies that the modulating effects on autonomic function deriving from the hemisp here were probably disturbed, owing to the brain lesions that each of the s tudy group patients had already sustained. Conclusions: A disturbed balance of activity between the sympathetic and parasympathetic nervous system mig ht result from the loss of hemispheric influence in patients with epilepsy. Nevertheless, further investigation is clearly necessary to ascertain the possible association of this disturbed balance with SLIDER Further investig ation is also needed to establish the exact location of the region in the b rain that gives rise to this modulating influence.