Lack of Evidence of Myocardial Injury Following Complex Partial and Secondarily Generalized Tonic-Clonic Seizures
Abstract number :
2.146
Submission category :
Year :
2001
Submission ID :
2983
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
B. Woodruff, MD, Neurology, Mayo Clinic, Rochester, MN; J.W. Britton, MD, Neurology, Mayo Clinic, Rochester, MN; S. Tigaran, MD, Neurology, Aarhus University Hospital, Aarhus, Denmark; A.S. Jaffe, MD, Cardiology, Mayo Clinic, Rochester, MN; G.D. Cascino,
RATIONALE: Two to 17% of deaths in the epilepsy population are attributable to sudden unexplained death in epilepsy (SUDEP). It has been postulated that SUDEP may result from subtle cardiac injury induced during seizure activity. To evaluate this possibility, we measured cardiac troponin T and I (cTnT and cTnI) concentrations, which are sensitive markers of myocardial injury in patients following recorded seizures.
METHODS: Adult patients admitted to the Epilepsy Monitoring Unit for pre-surgical monitoring and management of intractable epilepsy were enrolled after informed consent was obtained. Exclusion criteria included age less than 18, history of major cardiac illness within the preceding month, and seizure types other than complex partial or secondarily generalized tonic-clonic seizures. Twenty-one patients were offered enrollment, and four declined. Baseline cTnT and cTnI concentrations and 12-lead ECG recordings were obtained in all seventeen patients enrolled. cTnT was measured on the Elecys analyzer (Roche) and cTnI with the Stratus CS analyzer (Dade-Behring). Complex partial seizures were recorded in seven patients, secondarily generalized tonic-clonic seizures in four, and no seizures were recorded in six who served as controls. Serial cTnT and cTnI levels were obtained at 8, 24, and 48 hours following a recorded complex partial or generalized tonic-clonic seizure. 12-lead ECG recordings were performed as soon as possible following seizure activity, and were accomplished within 20 minutes of seizure onset in all patients. A repeat ECG was recorded 24 hours after seizure onset in all patients with a recorded seizure. In the six controls, serum cTnT and cTnI levels and a 12-lead ECG were obtained at dismissal.
RESULTS: Baseline troponin values were normal or undetectable ([lt]0.01 for cTnT and [lt]0.06 for cTnI) in all subjects. Changes from baseline did not occur in any of the subsequent samples. No ischemic changes were seen on the post-ictal ECGs.
CONCLUSIONS: No evidence of cardiac injury was demonstrated after typical complex partial or secondary generalized tonic-clonic seizures, even when the most sensitive assays currently available for cTnT and cTnI were used. Thus, clinically significant cardiac injury does not appear to occur after the average uncomplicated seizure. We found no evidence of ischemia on ECG. These data also suggest that if serum troponin elevations are seen in the setting of uncomplicated seizure activity, that concomitant cardiac disease should be suspected.
Support: Mayo Foundation