cTnI, BNP and CRP profiling after seizures in patients with drug-resistant epilepsy

Abstract

To profile serum levels of high sensitivity Troponin I (hs-cTnI), B-Type Natriuretic Peptide (BNP), and high sensitivity C Reactive Protein (hs-CRP), after epileptic seizures in patients with focal drug-resistant epilepsy, relating the results to the revised SUDEP-7 inventory. Methods: We prospectively evaluated patients admitted to our Epilepsy Monitoring Unit. hs-cTnI, BNP, and hs-CRP were measured at admission and after the first seizure. The revised SUDEP-7 Risk Inventory was calculated. The statistical significance level was set at 0.05. Results: Fifty-eight patients were included (53.4 % female). The index seizure was a focal to bilateral tonic-clonic seizure (FBTCS) in 25.9 % of the patients, and 17.5 % had post-ictal generalized EEG suppression (PGES). After the seizure, 25.9 % had a significant (above 50 %) increase in hs-cTnI, 23.3 % in BNP, and 4.3 % in hs-CRP. About 40 % had cardiovascular risk factors (CRF), without known cardiac disease. The elevation of one biomarker did not compel the elevation of another. hs-cTnI increase was associated with FBTCS, PGES, longer seizures, maximal ictal heart rate, and HR change. Increases in BNP were associated with CRF. hs-CRP increase was associated with PGES. We found no significant association between SUDEP-7 and any biomarker increase. Significance: Several patients had increases in biomarkers of myocardial necrosis/dysfunction after seizures, without significant association with the SUDEP-7 inventory. Different patterns of biomarkers' elevations point to multifactorial pathophysiologies hypothetically associated with incipient myocardial lesions. A larger cohort with follow-up data could help to clarify the clinical relevance of these findings.

Cardiac Abnormalities in Refractory Status Epilepticus-an Exploratory Study

“… 5 The most common abnormality in this group was raised cardiac enzymes, either one or both being positive in 90.0%. On the contrary, troponin levels drawn at SE onset were elevated in only 39.1% as noted by Hocker et al 5 Similarly, frequency of patients with raised NT NT-proBNP in RSE was higher in our study than noted by Faria et al 20 (23.0%). QTc prolongation was the next most common cardiac injury marker (70.0%), higher than noted by Hocker et al 5 (22.9%).…”

Neurological update: use of cardiac troponin in patients with stroke

“…Contraction band necrosis is a distinct myocardial lesion seen in patients with sympathetic overdrive and has been attributed to a direct catecholamine toxicity [ 41 ]. A temporal rise of hs-cTn can also be observed after seizures and has been associated with focal to bilateral-tonic clonic seizure type, longer seizure duration, and higher ictal heart rate [ 42 ]. Another study found hs-cTn elevation in 26% of patients with generalized onset seizures [ 43 ].…”

Classification Model for Epileptic Seizure Using Simple Postictal Laboratory Indices

“…It is especially helpful in differentiating generalized tonic-clonic seizures (GTCS) when elevated. Contrarily, in a Korean study, the serum level of brain-type natriuretic peptide (BNP) did not show usefulness in differentiating seizure and vasovagal syncope in the clinical setting [ 7 , 8 ].…”