Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus

Ibrahim, Ahmed; Megahed, Ahmed; Salem, Alaa; Zekry, Osama

doi:10.3390/children9020122

Cited by 3 publications

(5 citation statements)

References 39 publications

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“…This study agree with the result of the study obtained by A, et al, [21], who had studied serum level of cardiac troponin (cTn-I) and myocardial functions in the form of electrocardiography (ECG) and echocardiography changes in children with convulsive status epilepticus.…”

Section: Discussionsupporting

confidence: 92%

Cardiac Troponin (cTnI) Level and Myocardial Functions in Children with Idiopathic Convulsive Status Epilepticus

Megahed,

Aziz,

El-Serogy

et al. 2023

JAMMR

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Background: A Seizure represents the clinical expression of abnormal, excessive, synchronous discharges of neurons residing primarily in the cerebral cortex. The aim of this study is to evaluate the myocardial functions and serum cardiac troponin (cTn-I) in children with convulsive status epilepticus without evidence of previous cerebrovascular diseases. Methods: This study was a case control study which was carried out in the duration of 1 year from December 2021 to December 2022 in Tanta University Hospital, Pediatric Department, Intensive care unit (ICU) and the emergency room. The diagnosis of status epilepticus had been made in accordance with the criteria of the International League against Epilepsy clinically as a generalized seizure (epileptic seizure with duration more than 5 minutes or recurrent again without regaining consciousness in between seizures). Another thirty (30) healthy children (16 males, 14 female) with age range from (3-15) years, with the mean age was (6.367±3.449) years, with no history of epilepsy or family history of neurological diseases, were enrolled in this study and were served as control group. Inclusion criteria were no sex predilection, Patients with age of (3-15) years, and children with convulsive status epilepticus. Convulsion type with duration more than 5 minutes or recurrent again without regaining consciousness in between seizures. Results: There was significant increase in serum level of cardiac troponin cTn-I among children with idiopathic convulsive status epilepticus than healthy Control children, (P <0.001*). All patients with elevated serum levels cTn-I had documented ECG changes. The test result had a high positive predictive value which indicates high specificity of the of mean serum level of cardiac troponin test and that, Children have high probability of having myocardial ischemia and injury following attacks of idiopathic convulsive status epilepticus. Conclusions: Convulsive status epilepticus triggers severe physical activities, while skeletal muscle contraction increases the cardiac afterload in the tonic stage, leading to a transient imbalance in the cardiac tissue demand, which is associated with myocardial cell damage. Neural-hormonal factors contribute to myocardial cell damage (e.g., prolonged seizure activity that occurs in status epilepticus).

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Section: Discussionsupporting

confidence: 92%

Cardiac Troponin (cTnI) Level and Myocardial Functions in Children with Idiopathic Convulsive Status Epilepticus

Megahed,

Aziz,

El-Serogy

et al. 2023

JAMMR

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“…In a similar study on RSE, mortality in cardiac injury group comprised 45.5%, while it was only 15.4% in those without ( p =0.14). 5 Likewise, Ibrahim et al 23 showed that mortality rate was higher among patients of CSE with cardiac injury (13.9% vs. 2.6% without) confirming the role of cardiovascular complications in death in CSE. 23 In fact, Kurukumbi et al 24 reported that all deaths due to CSE had ECG abnormalities.…”

Section: Discussionmentioning

confidence: 93%

Cardiac Abnormalities in Refractory Status Epilepticus-an Exploratory Study

Saroha,

Panda,

Deora

et al. 2023

J Epilepsy Res

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Background and Purpose: Cardiac abnormalities have been reported during ongoing seizures and refractory status epilepticus (RSE). Reduced heart rate variability (HRV) and cardiac arrhythmias may contribute to sudden unexpected death in epilepsy. We sought to explore the utility of electrocardiographic and echocardiographic changes in patients with RSE prognosis and functional outcome.Methods: Patients of RSE underwent electrocardiogram (ECG), holter, troponin-I (Trop I), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and 2-dimensional echocardiogram (2D Echo) along with continuous electroencephalogram in first 24 hours and admission. Heart rate changes/arrhythmias, corrected QT interval (QTc) and HRV, ventricular dysfunction or regional motion wall abnormality were studied on 2D Echo. These parameters were also at baseline, at discharge or death and 30 days post discharge.Results: This prospective observational study conducted over 18 months enrolled 20 patients with RSE, fulfilling the inclusion criteria. Mean age was 47.75±17.2 years with male: female ratio of 1:1. Mean time to presentation from seizure onset was 8.80±7.024 hours. Central nervous system infection (35.0%), autoimmune encephalitis (20.0%) and cerebrovascular disease (20.0%) were the common etiologies. Amongst cardiac injury markers, cardiac enzymes and QTc prolongation were the commonest abnormalities in RSE. Both reduced HRV and presence of cardiac injury markers had significant correlation with poor outcome along with poor Glasgow coma scale (GCS) and modified Rankin scale (mRS) at presentation, and presence of non convulsive status epilepticus (NCSE).Conclusions: Presence of poor GCS, poor mRS, markers of cardiac injury, reduced HRV and occurrence of NCSE have a consistent correlation with mortality and poor clinical outcome. Therefore, routine assessment of cardiac abnormalities using affordable, easily accessible and non-invasive tools such as ECG, 2D Echo, holter NT-proBNP and Trop I is recommended in RSE patients.

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“…After convulsions, a significant proportion of patients exhibited elevated biomarkers associated with cardiac necrosis and dysfunction, potentially suggesting the initiation of myocardial harm (1) .…”

Section: Discussionmentioning

confidence: 99%

“…The principal aim of this study was to assess ECG parameters in pediatric patients presenting with various causes of convulsions. Ibrahim et al (1) performed a similar prospective observational study to determine the effect of cardiac injury on the clinical course of paediatric patients with convulsive status epilepticus. Echocardiography, cardiac troponin, and ECG were used to assess cardiac injury.…”

Section: Discussionmentioning

confidence: 99%

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ECG Changes in Children with Convulsions at Sohag University Hospital

2024

The Egyptian Journal of Hospital Medicine

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Background: Convulsion is a common problem encountered in the emergency department and represent a major source of morbidity, many children are admitted to emergency department and PICU with different clinical types of convulsions due to different etiologies. Frequent electrocardiographic (ECG) alterations are commonly observed during and following convulsions, indicating that individuals experiencing convulsions often possess significant risk factors for cardiac strain, which in turn typically correlates with elevated morbidity and mortality rates. Objective: To identify electrocardiogram (ECG) abnormalities in pediatric patients with various etiologies of convulsions. Patients and Methods: This cross-sectional hospital-based research was carried out at Pediatric Emergency Department and PICU at Sohag University Hospital during the period from January 2022 to September 2023. 12 leads ECG had been done to all children aged one month to eighteen years old who presented to the Pediatric Emergency Department with convulsions. Results: 200 children were included in the study, 104 (52%) males and 96 (48%) females with male to female ratio was 1.08:1. The age of children ranged between 1 month to 12 years with mean age was 3.75± 3.19 years. More than half of children (58%) were between 2-10 years and the least group represented was between 11-18 years (3%). Consanguinity was reported in more than half of children (57%). Encephalopathy was the most common cause of convulsions in children (34%), generalized tonic-clonic convulsions was the most frequent type of convulsions (89%). A statistically significant distinction was discovered among types of convulsions related to PR interval (p<0.001) as it was highest in epilepsy. However, no significant variance was found among types of convulsions related to QTc interval (p=0.220). Conclusion: QTc interval was not significantly varied amongst the various seizure sources. There was significant variance among various causes of convulsions as regard heart rate and PR interval.

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Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus

Cited by 3 publications

References 39 publications

Cardiac Troponin (cTnI) Level and Myocardial Functions in Children with Idiopathic Convulsive Status Epilepticus

Cardiac Troponin (cTnI) Level and Myocardial Functions in Children with Idiopathic Convulsive Status Epilepticus

Cardiac Abnormalities in Refractory Status Epilepticus-an Exploratory Study

ECG Changes in Children with Convulsions at Sohag University Hospital

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