Abstracts

Rationale: Sudden unexpected death in epilepsy (SUDEP) is an important cause of mortality in patients with epilepsy. Myocardial ischemia has been proposed as a possible cause of SUDEP, however, there is paucity of research performed in pediatric patients. We aimed to evaluate the presence of myocardial injury during convulsive seizures by determining serum concentrations of cardiac troponin I (cTnI) and CK-MB mass and plasma levels of Brain-Type Natriuretic Peptide (BNP).Methods: Thirty-one children (20 boys, age range: 0,9 -16 years; median: 4 ± 5,34 years) who were admitted to Baskent University Hospital with febrile or afebrile tonic-clonic seizures and 50 healthy children with similar age distribution were enrolled. Serum cTnI, CK-MB mass and BNP concentrations were analyzed 12 hours after the seizure and repeated 7 days thereafter in the patient group. cTnI, CK-MB mass and BNP concentrations were obtained once in the control group. Results: Serum concentrations of cTnI 12 h (median : 0,02 ± 0.019 ng/mL) and 7 days after the seizure (median: 0,03 ± 0.034 ng/mL) were not significantly different. Serum concentration of CK-MB mass at the 12 th h (median: 2,90 ± 3.00 µg/L) was significantly higher than that of the 7 th day (median :1,90 ± 1.83 µg/L) (p<0.05). Similarly, plasma concentration of BNP was significantly higher 12 h postictal (median: 16,90 ± 68,31 pg/mL ) compared to 7 days postictal (median: 5,00± 8,89 pg/mL ) (p<0.001). cTnI levels 12 h postictal and those in controls (median : 0.030 ± 0.038 ng/mL) were not signifantly different. Comparison of CK-MB mass and BNP levels at the 12 th h after the seizure and those in the control group (CK-MB; median: 1,80 ± 1,517 µg/L), (BNP; median : 5,00 ± 3,58 pg/mL ) revealed increased CK-MB mass and BNP levels in children with seizures (p<0.05 and p<0.001, respectively). Conclusions: Normal cTnI levels show that there is no evidence of overt myocardial necrosis in patients with convulsive seizures. However, markedly elevated BNP concentrations together with elevated CK-MB mass levels suggest subtle cardiac dysfunction associated with convulsions. Further large-scale studies are warranted for the explanation of post-seizure elevation of both BNP and CK-MB mass levels.