Prevalence and Risk Factors of Peri-ictal Autonomic Changes in Children With Temporal Lobe Seizures

Background We determined the prevalence of signs and symptoms of autonomic dysfunction in seizures of temporal lobe onset in children. Methods We evaluated the prevalence and risk factors of peri-ictal autonomic changes in temporal lobe onset seizures in children from a single-center pediatric epilepsy monitoring unit between June 1, 2009 and October 31, 2013. Age, gender, epilepsy etiology, current antiepileptic drug therapy, ictal electroencephalographic lateralization, brain magnetic resonance imaging results, and the presence of generalized tonic-clonic seizures over the preceding year were recorded from medical record review. Results Forty-nine children were identified (55% male, median age 10.1 years [interquartile range 5.5 to 13.9 years]). Overall, peri-ictal autonomic changes were observed in 32 of 49 patients (66%) and 91 of 172 evaluated seizures (53%). Tachycardia (51%), oxygen desaturation (33%), and salivation (27%) were the most frequent autonomic changes identified. Bradycardia occurred in one patient (2%). Conclusions Among pediatric patients with temporal lobe seizures, peri-ictal autonomic changes are frequent yet seldom require intervention.