Ictal tachycardia in children with epilepsy

•Ictal changes in heart rate (HR) have been shown as useful biomarkers in the development of automatic seizure detection devices, in order to alert the patients’ caregivers and improve their safety.•They may provide important information about the pathophysiological mechanisms contributing to sudden unexpected death in epilepsy (SUDEP).•Knowing the differences in the frequency and mode of presentation of ictal tachycardia in children at different ages could help design detection algorithms more appropriate for these age groups. Likewise, it could help understand the mechanisms and the lower incidence of SUDEP in children.•Ictal tachycardia occur frequently in children: it was present in at least one seizure in 70.3 % of patients and in 51.1 % of all seizures. >30 % of patients had ictal tachycardia in all of their seizures, this being significantly more frequent (>40 %) in children older than 6 years.•Ictal tachycardia was significantly more frequent in focal seizures, in seizures longer than 1 min and in seizures occurring in sleep. Early ictal tachycardia was significantly more frequent in seizures with motor signs and in seizures during sleep.•Children older than 6 years especially with focal seizures during sleep could be ideal candidates for warning devices or stimulation therapies triggered by tachycardia detection. Changes in heart rate (HR) may provide an extracerebral indicator of seizure onset. The purpose of this study is to assess the frequency and timing of presentation of ictal tachycardia in a larger series of children with epilepsy grouped in different age groups as well as the influence of seizure characteristics. We retrospectively reviewed 732 seizures of 195 patients aged 0 to 14 (median 6.91) years with epilepsy of any cause. Patients were grouped according to the age in groups (1) 30 % of patients had ictal tachycardia in all of their seizures, this being more