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Interictal cardiac repolarization abnormalities improve after surgical seizure resolution in pediatric drug‐resistant epilepsy.

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Title: Interictal cardiac repolarization abnormalities improve after surgical seizure resolution in pediatric drug‐resistant epilepsy.
Authors: Bozdag, Ege (AUTHOR), Makaram, Navaneethakrishna (AUTHOR), Sabino, Giovanna (AUTHOR), Bolton, Jeffrey (AUTHOR), Grant, Ellen P. (AUTHOR), Rotenberg, Alexander (AUTHOR), Tamilia, Eleonora (AUTHOR)
Source: Epilepsia (Series 4). Jun2026, Vol. 67 Issue 6, p3034-3047. 14p.
Subjects: Epilepsy surgery, Biomarkers, Childhood epilepsy, Heart beat, Seizures (Medicine)
Abstract: Objective: The current work aims to study interictal T‐wave alternans (TWA), a biomarker of cardiac repolarization instability that is elevated in epilepsy, in children with drug‐resistant epilepsy (DRE) and to test whether it normalizes following postoperative seizure resolution. Methods: In this cohort study, we studied children with DRE who underwent successful epilepsy surgery (Engel class IA). Interictal TWA was computed before and after surgery using electrocardiographic data collected during electroencephalographic video monitoring. These values were compared to each other (Wilcoxon signed‐rank test) and to healthy controls (Wilcoxon rank‐sum test). Heart rate (HR) and HR variability (HRV) were also assessed and compared. Correlations with clinical variables, including time since surgery and number of antiseizure medications, were analyzed. Results: Preoperative TWA was elevated in children with DRE compared to healthy controls (25.5 μV vs. 13.7 μV, p =.009). Following surgery in DRE, TWA decreased (17.9 μV, p =.002) and was no longer different from control levels (p =.81). Preoperative HRV was reduced compared to controls (p =.02) and did not change postoperatively (p =.70). The TWA percent change did not correlate with the time elapsed since surgery (p =.26). Significance: Interictal TWA is elevated in children with DRE and normalizes following successful surgical treatment, suggesting that epilepsy‐associated cardiac repolarization instability is reversible. TWA may serve as a dynamic biomarker of epilepsy‐related cardiac stress and recovery, with potential utility in monitoring treatment response and stratifying cardiac risk. We provide the first evidence that cardiac electrical instability in pediatric DRE, as measured by TWA, improves after seizure resolution through surgery. These findings highlight the relevance of noninvasive cardiac biomarkers in epilepsy management and support further research into TWA as a marker of systemic recovery after surgical seizure treatment. [ABSTRACT FROM AUTHOR]
Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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DbLabel: Psychology and Behavioral Sciences Collection
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PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Interictal cardiac repolarization abnormalities improve after surgical seizure resolution in pediatric drug‐resistant epilepsy.
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Bozdag%2C+Ege%22">Bozdag, Ege</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Makaram%2C+Navaneethakrishna%22">Makaram, Navaneethakrishna</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sabino%2C+Giovanna%22">Sabino, Giovanna</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bolton%2C+Jeffrey%22">Bolton, Jeffrey</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Grant%2C+Ellen+P%2E%22">Grant, Ellen P.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rotenberg%2C+Alexander%22">Rotenberg, Alexander</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tamilia%2C+Eleonora%22">Tamilia, Eleonora</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Epilepsia+%28Series+4%29%22">Epilepsia (Series 4)</searchLink>. Jun2026, Vol. 67 Issue 6, p3034-3047. 14p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Epilepsy+surgery%22">Epilepsy surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Biomarkers%22">Biomarkers</searchLink><br /><searchLink fieldCode="DE" term="%22Childhood+epilepsy%22">Childhood epilepsy</searchLink><br /><searchLink fieldCode="DE" term="%22Heart+beat%22">Heart beat</searchLink><br /><searchLink fieldCode="DE" term="%22Seizures+%28Medicine%29%22">Seizures (Medicine)</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: The current work aims to study interictal T‐wave alternans (TWA), a biomarker of cardiac repolarization instability that is elevated in epilepsy, in children with drug‐resistant epilepsy (DRE) and to test whether it normalizes following postoperative seizure resolution. Methods: In this cohort study, we studied children with DRE who underwent successful epilepsy surgery (Engel class IA). Interictal TWA was computed before and after surgery using electrocardiographic data collected during electroencephalographic video monitoring. These values were compared to each other (Wilcoxon signed‐rank test) and to healthy controls (Wilcoxon rank‐sum test). Heart rate (HR) and HR variability (HRV) were also assessed and compared. Correlations with clinical variables, including time since surgery and number of antiseizure medications, were analyzed. Results: Preoperative TWA was elevated in children with DRE compared to healthy controls (25.5 μV vs. 13.7 μV, p =.009). Following surgery in DRE, TWA decreased (17.9 μV, p =.002) and was no longer different from control levels (p =.81). Preoperative HRV was reduced compared to controls (p =.02) and did not change postoperatively (p =.70). The TWA percent change did not correlate with the time elapsed since surgery (p =.26). Significance: Interictal TWA is elevated in children with DRE and normalizes following successful surgical treatment, suggesting that epilepsy‐associated cardiac repolarization instability is reversible. TWA may serve as a dynamic biomarker of epilepsy‐related cardiac stress and recovery, with potential utility in monitoring treatment response and stratifying cardiac risk. We provide the first evidence that cardiac electrical instability in pediatric DRE, as measured by TWA, improves after seizure resolution through surgery. These findings highlight the relevance of noninvasive cardiac biomarkers in epilepsy management and support further research into TWA as a marker of systemic recovery after surgical seizure treatment. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1002/epi.70206
    Languages:
      – Code: eng
        Text: English
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      Pagination:
        PageCount: 14
        StartPage: 3034
    Subjects:
      – SubjectFull: Epilepsy surgery
        Type: general
      – SubjectFull: Biomarkers
        Type: general
      – SubjectFull: Childhood epilepsy
        Type: general
      – SubjectFull: Heart beat
        Type: general
      – SubjectFull: Seizures (Medicine)
        Type: general
    Titles:
      – TitleFull: Interictal cardiac repolarization abnormalities improve after surgical seizure resolution in pediatric drug‐resistant epilepsy.
        Type: main
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            NameFull: Bozdag, Ege
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            NameFull: Makaram, Navaneethakrishna
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            NameFull: Sabino, Giovanna
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            NameFull: Bolton, Jeffrey
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            NameFull: Grant, Ellen P.
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            – D: 01
              M: 06
              Text: Jun2026
              Type: published
              Y: 2026
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              Value: 67
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            – TitleFull: Epilepsia (Series 4)
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