Elevated CK‐MB mass and plasma brain‐type natriuretic peptide concentrations following convulsive seizures in children and adolescents: Possible evidence of subtle cardiac dysfunction

Abstract

Summary Purpose: To evaluate the presence of myocardial injury during convulsive seizures in children and adolescents by determining serum concentrations of cardiac troponin I (cTnI), creatine kinase‐MB mass (CK‐MB mass), and plasma brain‐type natriuretic peptide (BNP). Methods: Thirty‐one children (20 boys; mean age, 6.6 ± 5.34 years) with convulsive seizures and 50 healthy children were enrolled. Serum cTnI, CK‐MB mass, and plasma BNP concentrations were analyzed 12 h after the seizure and repeated 7 days thereafter in the patient group and obtained one time in the control group. Results: The difference between serum concentrations of cTnI obtained 12 h and 7 days after the seizure was not statistically significant. cTnI levels 12 h postictal and those in control subjects also were not significantly different. CK‐MB mass and BNP at the 12th h were higher than those obtained on the 7th day (p < 0.05 and p < 0.001, respectively). Children with seizures had increased levels of CK‐MB mass and BNP 12 h after seizure than control subjects (p < 0.05 and p < 0.001, respectively). The results of electrocardiography (ECG) recordings, which were obtained up to 30 min after seizure activity, were completely normal in patients with seizure. Conclusion: Normal cTnI levels are not indicative of overt myocardial necrosis in patients with seizures. However, markedly elevated BNP concentrations together with elevated CK‐MB mass levels do suggest subtle cardiac dysfunction in patients with seizure, and further large‐scale studies are warranted.

Cardiac and Autonomic Mechanisms Contributing to SUDEP

“…Transient myocardiac ischemia likely results from increased perfusion demand, ictal tachycardia, and hypoxemia . Subtle elevation of ischemic cardiac markers as CK-MB and braintype natriuretic peptide have been found in the postictal period in children with convulsive seizures, but no troponin elevation has been found in response to epileptic seizures in adult patients with no known coronary disease (Alehan et al, 2009;Woodruff et al, 2003). These findings may be the expression of mild and reversible ischemic changes without cardiac infarction.…”

Plasma Brain-Type Natriuretic Peptide Level Following Seizure and Syncope: Pilot Study

“…Seizure provokes an increase of sympathetic tone, which, in turn, may stimulate the release of proBNP from cardiomyocytes. The latter possibility was indirectly supported by the findings that both CK-MB and proBNP increase simultaneously following seizure 2. However, this explanation is further complicated because vasovagal syncope also activates sympathetic tone temporarily,15 which may increase proBNP according to the same assumption 11.…”

“…The duration of preceding symptom is usually short in cases of cardiogenic syncope like as seizure attack 1. To differentiate the two diseases clearly, some biomarkers favoring a seizure attack in blood or cerebrospinal fluid (CSF), have been proposed,2–6 but its clinical application has not made yet.…”

Heart-type fatty acid-binding protein as a predictor of cardiac ischemia in intractable seizures in children

“…could show the presence of elevated brain-natriuretic peptide and creatine kinase in patients with seizures, the first evidence of subtle cardiac dysfunction in epilepsy patients. [21] However, previous studies failed to show significant increase in the serum levels of cardiac troponin as a marker of myocardial ischemia following seizures. [19212223] On the other hand, earlier studies using other markers reported a significant increase in brain-natriuretic peptide in the first postictal hour.…”