Evaluating the Effects of Levetiracetam on the Cardiac Autonomic Activity of Children with Epilepsy Compared to Carbamazepine

INTRODUCTION: A healthy balance between the sympathetic and parasympathetic nervous systems is necessary
for normal heart rate variability (HRV), which is the fastest and least intrusive method for
examining data on autonomic modulation of the heart rate. This research aimed to evaluate autonomic cardiac profile changes in children with epilepsy using levetiracetam (LEV) and carbamazepine (CBZ) by analyzing heart rate variability.
METHODS: In this retrospective controlled study, children attempting to go to the pediatrics clinic between October 2020 and December 2022 were subjected to research and divided into three groups: epilepsy using LEV (n=39), using CBZ (n=39), and healthy controls (n=41). Echocardiogram, electroencephalogram, and 24-hour ambulatory electrocardiogram for HRV parameters were evaluated.
RESULTS: The HRV demonstrated no disparities between types of epilepsy, duration of epilepsy, or EEG abnormality. SDNN was considerably lower in children with epilepsy in comparison to healthy controls (p<0.05). The SDNN and pNN50 values of the children using CBZ were considerably lower than those of those using LEV and controls (p<0.05 and p<0.05).Healthy controls showed signs of higher sympathetic tone in cardiac autonomic function compared to children with epilepsy.
DISCUSSION AND CONCLUSION: The children on carbamazepine monotherapy resulted in a more pronounced decrease in parasympathetic tone compared to those treated with LEV or healthy controls. Children on LEV monotherapy don’t alter autonomic cardiovascular functions compared to children with epilepsy on CBZ monotherapy. The recommended use of Holter monitoring and electrocardiographic evaluation can achieve early detection of cardiac complications in high-risk children with epilepsy.

Keywords: Heart rate variability, levetiracetam, carbamazepine, epilepsy, children.