CTnI, BNP and CRP profiling after seizures in patients with drug-resistant epilepsy. (August 2020)

• Record Type: Journal Article
• Authors: Faria, Maria Teresa; Rego, Ricardo; Rocha, Helena; Sá, Francisca; Farinha, Rui; Oliveira, Ana; Barata, Pedro; Alves, Dílio; Pereira, Jorge; Rocha-Gonçalves, Francisco; Gonçalves, Hernâni; Martins, Elisabete
• Is Part Of: Seizure. Volume 80(2020)
• Page Start: 100
• Page End: 108
• Publication Date: 2020-08
• Subjects: hs-cTnI high sensitivity troponin I -- BNP B-type Natriuretic Peptide -- hs-CRP high sensitivity C reactive protein -- FBTCS focal to bilateral tonic-clonic seizure -- FS focal seizure without evolution to bilateral tonic-clonic seizure -- GTCS Generalized Tonic-clonic Seizure -- PGES post-ictal generalized EEG suppression -- CRF cardiovascular risk factors -- maxHR maximal ictal heart rate -- Δ HR heart rate change -- SUDEP Sudden Unexpected Death in Epilepsy -- EMU Epilepsy Monitoring Unit -- CMIA Chemoluminescent Microparticle Immuno Assay -- VC Variation Coefficient -- AED antiepileptic drugs -- EKG electrocardiogram -- TLE temporal lobe epilepsy; SUDEP -- Troponin -- BNP -- CRP -- Seizures -- SUDEP-7; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2020.06.003
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: We searched for a relationship between cardiac biomarkers and the SUDEP-7 inventory. Increases in hs-cTnI and/or BNP after seizures were independent from the inventory. hs-cTnI increases were associated with FBTCS, PGES, longer seizures, maxHR and ΔHR. Increases in BNP were associated with cardiovascular risk factors. Different patients had elevations in different biomarkers - multifactorial lesions? Abstract: Purpose: 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.