The potential for QT prolongation by antiepileptic drugs in children

Cardiac arrhythmia may be one of the major causes of sudden unexpected death in children with epilepsy. We assessed drug-induced QT prolongation to establish whether the use of antiepileptic drugs contributes to sudden unexpected death. A total of 178 children with epilepsy (93 males and 85 females, with ages ranging from 1 month to 18.9 years; mean age 7.0 ± 4. 1 years) were involved in the study. The QT intervals were manually measured and corrected using Fridericia's formula (QTFc = QT/RR^1/3). The mean corrected QT interval (QTc) of 152 children on antiepileptic drugs during the study period was 0.40 ± 0.03 s, and for 26 age-matched, antiepileptic drug-free control patients it was 0.40 ± 0.03 s. The mean QTc of the children with monotherapy was 0.40 ± 0.03 s for the valproate group (n = 42), 0.39 ± 0.02 s for the carbamazepine/oxcarbazepine group (n = 34), and 0.40 ± 0.02 s for the topiramate group (n = 26), respectively. There was no statistically significant difference among the groups as assessed by analysis of variance. In addition, there was no significant difference between the monotherapy group (n = 109; 0.40 ± 0.02 s) and the polytherapy group (n = 43; 0.39 ± 0.03 s). Major antiepileptic drugs may not precipitate prolongation of the QT interval into sudden unexpected death in children with epilepsy, however further studies are required.