Can heart rhythm tests predict seizures in children with epilepsy?
Heart rhythm tests, such as electrocardiogram (ECG), measure the electrical activity of the heart. In children with epilepsy, seizures can sometimes affect heart rate, causing it to speed up (tachycardia) or slow down (bradycardia). Researchers are studying whether these heart rate changes can be used to predict when a seizure is about to happen. While there is some evidence that heart rhythm changes occur before certain seizures, current tests are not accurate enough to reliably predict seizures in everyday life.
What the research says
A systematic review of 11 studies found that cardiovascular biomarkers, especially those measured by ECG, are the most commonly studied non-invasive method for forecasting seizures in children with epilepsy 4. Some algorithms could anticipate seizures minutes before they started, but the review noted that more research is needed before these tools are ready for clinical use 4.
Specific heart rhythm changes have been linked to seizures. For example, ictal tachycardia (a fast heart rate during a seizure) was seen in about one-third of seizures in one study, often when the seizure started in the temporal lobe 10. On the other hand, ictal asystole (a temporary stop in heartbeats) is rare, occurring in less than 1% of people with epilepsy, and is mostly seen in focal epilepsy 9. This sudden drop in heart rate can cause a loss of muscle tone and may be a risk factor for sudden unexpected death in epilepsy (SUDEP) 9.
While these findings show a clear link between heart rhythm and seizures, the evidence is not strong enough to recommend heart rhythm tests as a reliable seizure prediction tool for children. The systematic review emphasized that current studies are small and use different methods, so larger, more consistent trials are needed 4.
What to ask your doctor
- Could my child's heart rate changes during seizures provide any clues about their seizure type or risk?
- Are there any ongoing studies or clinical trials using heart rhythm monitoring to predict seizures in children?
- Should my child have an ECG or other heart test as part of their epilepsy evaluation?
- What are the signs of ictal asystole or dangerous heart rate changes during a seizure that I should watch for?
- How do heart rhythm tests compare with other seizure prediction methods, like EEG or wearable devices?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.