Abstracts

Rationale: Status epilepticus is known to be accompanied by acute activation of the sympathetic nervous system which could result in myocardial insult. Cardiac arrhythmia associated with myocardial injury is a proposed mechanism for sudden unexplained death in epilepsy. Prior studies have shown that changes on electrocardiography suggestive of a myocardial infarction in patients with status epilepticus portend an increased risk of morbidity and mortality. However, data regarding significance of elevated troponin in patients with status epilepticus is limited.Methods: We did a retrospective chart analysis on all patients aged 18 years and older, diagnosed with status epilepticus based on clinical and electroencephalographic findings at our institution between 2005 and 2010. Status epilepticus was defined as any seizure lasting greater than 30 minutes or intermittent ongoing seizures for 30 minutes or longer without regaining consciousness between the seizures. Data regarding age of patients, risk factors for coronary artery disease as defined by JNC 7 criteria and troponin levels during the period of status epilepticus were gathered and analyzed. Reference values for troponin I [ cardiac specific] concentration at our laboratory is negative if <0.1ng/ml , elevated if greater than 0.1 ng/ml. Results: We have analyzed 200 charts so far, and troponin level was checked co-incidentally along with other labs in 95 patients. Of these, a third of the patients [32/ 95] had an elevation of troponin while the other 63 patients showed no change. 20 of the 32 patients had troponin elevation, but a value less than 0.4 ng/ml. 90% [18/20] of this cohort had at least one risk factor for coronary artery disease. Of the 12 patients who had a troponin elevation greater than 0.4 ng/ml, all but one had a concurrent myocardial infarction diagnosed at the time of SE or within the next 24 hours. It was also noted that patients older than 60 years had a higher likelihood of having an elevated troponin [20/40] as opposed to those younger than 60 years [12/ 55]Conclusions: Elevated troponin levels are seen in patients with status epilepticus, especially in those with other cardiac risk factors and those older than 60 years. If there is concurrent myocardial infarction, these levels are higher. Given the fact that there is sympathetic overdrive during SE, we conclude that this elevation of troponin level is suggestive of myocardial stress and may contribute to increased mortality and/ or morbidity. We propose that troponin levels should be checked as a part of screening labs in all patients above age 60 years since all risk factors for coronary artery disease may not be know at presentation. If an elevation of troponin is found, further cardiac workup may be warranted once the patient is stabilized to assess further risk for developing a myocardial infarction.