# Assessing determinants of electrocardiographic alterations and identifying exacerbating factors in pediatric epilepsy

> **NIH NIH R21** · BAYLOR COLLEGE OF MEDICINE · 2021 · $369,560

## Abstract

PROJECT SUMMARY
Sudden unexpected death in epilepsy (SUDEP) is a significant cause of premature death in childhood-onset
epilepsy. Aberrant cerebral, respiratory and cardiac processes are candidate mechanisms underlying SUDEP.
In support of cardiac mechanism are the findings of higher risk of sudden cardiac arrest in adults with epilepsy,
and inter-ictal and peri-ictal electrocardiographic (ECG) abnormalities suggesting increased cardiac
vulnerability that results from myocardial remodeling. The appearance of high-risk arrhythmias with peri-ictal
hypoxemia suggests that respiratory derangements can also contribute to the cardiac abnormalities in
epilepsy. A longitudinal, population-based study of childhood-onset epilepsy has shown that the cumulative
SUDEP risk increases with increasing epilepsy duration, suggesting that there might be progressive changes
that contribute to mortality risk in adulthood. Our overarching hypothesis is that cardiac electrical
remodeling occurs as function of epilepsy duration and renders the heart vulnerable to stresses such
as seizures or respiratory derangements over time, thereby contributing to SUDEP. For this proposal we
will prospectively follow a cohort of pediatric epilepsy patients without a known ion channelopathy or cardiac
disease, who are managed in a quaternary epilepsy referral center using ECG studies as a surrogate marker.
We will obtain yearly ECG studies and collect clinical and laboratory data associated with each ECG. For
children enrolled in the study who are hospitalized for a respiratory illness during the study period, we will
obtain additional ECGs and collect additional clinical information relating to the hospitalizations. Using
multivariable models controlling for potential confounders such as seizure semiology and frequency, number of
anti-seizure medications, and other factors identified through univariate analyses, we will investigate whether
epilepsy duration is an independent risk factor for abnormal ECG. Using an analogous approach, we will also
evaluate whether an intercurrent respiratory illness is an independent risk factor for abnormal ECG, and
whether epilepsy duration modifies the likelihood of having an abnormal ECG during an intercurrent respiratory
illness.

## Key facts

- **NIH application ID:** 10302120
- **Project number:** 1R21NS119929-01A1
- **Recipient organization:** BAYLOR COLLEGE OF MEDICINE
- **Principal Investigator:** Yi-Chen Lai
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $369,560
- **Award type:** 1
- **Project period:** 2021-07-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10302120

## Citation

> US National Institutes of Health, RePORTER application 10302120, Assessing determinants of electrocardiographic alterations and identifying exacerbating factors in pediatric epilepsy (1R21NS119929-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10302120. Licensed CC0.

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