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

• Published in: Seizure (London, England) Vol. 80; pp. 100 - 108
• Main 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
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2020
• Subjects: BNP; C-Reactive Protein - analysis; CRP; Drug Resistant Epilepsy - blood; Female; Humans; Male; Natriuretic Peptide, Brain - blood; Seizures; Seizures - blood; SUDEP; SUDEP-7; Troponin; Troponin I - blood; PGES; AED; EKG; CRP; hs-cTnI; maxHR; BNP; EMU; TLE; FS; VC; FBTCS; Troponin; SUDEP; CRF; Δ HR; SUDEP-7; GTCS; hs-CRP; CMIA; Seizures
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2020.06.003

•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? 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. 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. 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. 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.