{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T12:54:03Z","timestamp":1782132843960,"version":"3.54.5"},"reference-count":53,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R03NS127044"],"award-info":[{"award-number":["R03NS127044"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The current work aims to study interictal T\u2010wave alternans (TWA), a biomarker of cardiac repolarization instability that is elevated in epilepsy, in children with drug\u2010resistant epilepsy (DRE) and to test whether it normalizes following postoperative seizure resolution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010rank test) and to healthy controls (Wilcoxon rank\u2010sum 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Preoperative TWA was elevated in children with DRE compared to healthy controls (25.5\u2009\u03bcV vs. 13.7\u2009\u03bcV,\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u2009.009). Following surgery in DRE, TWA decreased (17.9\u2009\u03bcV,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.002) and was no longer different from control levels (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.81). Preoperative HRV was reduced compared to controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.02) and did not change postoperatively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.70). The TWA percent change did not correlate with the time elapsed since surgery (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.26).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Interictal TWA is elevated in children with DRE and normalizes following successful surgical treatment, suggesting that epilepsy\u2010associated cardiac repolarization instability is reversible. TWA may serve as a dynamic biomarker of epilepsy\u2010related 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70206","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T14:46:35Z","timestamp":1773845195000},"page":"3034-3047","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interictal cardiac repolarization abnormalities improve after surgical seizure resolution in pediatric drug\u2010resistant epilepsy"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2858-0089","authenticated-orcid":false,"given":"Ege","family":"Bozdag","sequence":"first","affiliation":[{"name":"Fetal\u2010Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics Harvard Medical School, Boston Children\u2019s Hospital  Boston Massachusetts USA"},{"name":"School of Computation, Information, and Technology, Elite Master Program in Neuroengineering Technical University of Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5751-8842","authenticated-orcid":false,"given":"Navaneethakrishna","family":"Makaram","sequence":"additional","affiliation":[{"name":"Fetal\u2010Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics Harvard Medical School, Boston Children\u2019s Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9352-3373","authenticated-orcid":false,"given":"Giovanna","family":"Sabino","sequence":"additional","affiliation":[{"name":"Fetal\u2010Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics Harvard Medical School, Boston Children\u2019s Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2949-8722","authenticated-orcid":false,"given":"Jeffrey","family":"Bolton","sequence":"additional","affiliation":[{"name":"Division of Epilepsy and Clinical Neurophysiology, Department of Neurology Boston Children\u2019s Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1005-4013","authenticated-orcid":false,"given":"Ellen P.","family":"Grant","sequence":"additional","affiliation":[{"name":"Fetal\u2010Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics Harvard Medical School, Boston Children\u2019s Hospital  Boston Massachusetts 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