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Curso de Atualização em Medicina Cardiovascular 2019
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Cardiac damage biomarkers in patients with refractory epilepsy – is there any change after seizures?
Session:
Posters 3 - Écran 5 - Doença CV em populações especiais
Speaker:
Maria Teresa Faria
Congress:
CPC 2019
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.10 Neurologic Disorders and Heart Disease
Session Type:
Posters
FP Number:
---
Authors:
Maria Teresa Faria; Ricardo Rego; Francisca Sá; Helena Rocha; Rui Farinha; Ana Oliveira; Jorge Pereira; Francisco Rocha Gonçalves; Hernâni Gonçalves; Elisabete Martins
Abstract
<p><strong>Introducion:</strong> Possible mechanisms for Sudden Unexpected Death in Epilepsy (SUDEP) include cardiac dysfunction. Reports independently show elevations of high sensitivity Troponin I (hs-TnI), B-Type Natriuretic Peptide (BNP) or C reactive protein (CRP) after seizures (mainly generalized tonic-clonic seizures – GTCS).</p> <p><strong>Objective:</strong> To profile serum levels of hs-TnI, BNP and hs-CRP in patients with focal refractory epilepsy, after documented seizures, relating them to the revised SUDEP-7 inventory risk score.</p> <p><strong>Methods:</strong> From May.16 to Jul.18, we prospectively evaluated patients with focal refractory epilepsy admitted to our institution’s Epilepsy Monitoring Unit. Patients without seizures were excluded.</p> <p>All measurements were made at admission – basal – and 12-18 h after the first recognized seizure; hs-TnI and hs-CRP were also measured 6 h after the same seizure. We considered significant any increase above 50% of the basal level.</p> <p>Statistical significance was set at 0.05.</p> <p>The study was approved by our institution Ethics Committee. All patients gave their informed consent.</p> <p><strong>Results:</strong> 58 patients were included [53.4% ?; median age: 39.5 years (min-max, 16-73); median duration of epilepsy: 12 years (min-max, 1-67)]. 17.2% had GTCS, median duration of seizure was 70 s and 12.3% had post-ictal EEG suppression (PES). 38.6% had cardiovascular risk factors (CRF), without known cardiac disease.</p> <p>After the index seizure, 25.9% had a significant increase in hs-TnI, 23.3% in BNP, and 4.3% in hs-CRP. One patient had increases in both hs-TnI and BNP, and 2 in hs-TnI and hs-CRP. hs-TnI and hs-CRP increases were associated with the presence of both GTCS (p<0.001, p=0.035, respectively) and PES (p=0.001, p=0.015, respectively). hs-TnI increase was also associated with longer seizures (p=0.013). We found no significant differences in SUDEP-7 inventory classification between patients with and without either biomarker increase.</p> <p><strong>Conclusion:</strong> A considerable number of patients had an increase in biomarkers of myocardial necrosis/dysfunction after the seizure, but with no significant association with the SUDEP-7 inventory. Nonetheless, hs-TnI and hs-CRP increases were associated with the presence of both GTCS and PES (risk factors for SUDEP), and hs-TnI elevation was associated with longer seizures. Elevation of one biomarker did not compel the elevation of another, which could mean multifactorial causes to incipient myocardial damage leading to SUDEP.</p>
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