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

Shorbagy, Hatem HatemH El; El-Sayed, Mostafa A.; Kamal, Naglaa M.; Azab, Ahmed; Bassiouny, Mohamed M; Ghoneim, Ibrahim A.

doi:10.4103/1817-1745.193364

Cited by 7 publications

(5 citation statements)

References 41 publications

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“…Most have reported trends indicating a shift toward sympathetic dominance, although some failed to find statistically significant differences . In similarly designed studies of pediatric patients, the same patterns are typically seen, although children with drug‐resistant epilepsy often have more severe derangements …”

Section: Interictal Hrv Patterns In Different Epilepsy Typesmentioning

confidence: 95%

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

2018

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Our objective was to critically evaluate the literature surrounding heart rate variability (HRV) in people with epilepsy and to make recommendations as to how future research could be directed to facilitate and accelerate integration into clinical practice. We reviewed relevant HRV publications including those involving human subjects with seizures. HRV has been studied in patients with epilepsy for more than 30 years and, overall, patients with epilepsy display altered interictal HRV, suggesting a shift in autonomic balance toward sympathetic dominance. This derangement appears more severe in those with temporal lobe epilepsy and drug-resistant epilepsy. Normal diurnal variation in HRV is also disturbed in at least some people with epilepsy, but this aspect has received less study. Some therapeutic interventions, including vagus nerve stimulation and antiepileptic medications, may partially normalize altered HRV, but studies in this area are sometimes contradictory. During seizures, the changes in HRV may be complex, but the general trend is toward a further increase in sympathetic overactivity. Research in HRV in people with epilepsy has been limited by inconsistent experimental protocols and studies that are often underpowered. HRV measurement has the potential to aid clinical epilepsy management in several possible ways. HRV may be useful in predicting which patients are likely to benefit from surgical interventions such as vagus nerve stimulation and focal cerebral resection. As well, HRV could eventually have utility as a biomarker of risk for sudden unexpected death in epilepsy (SUDEP). However, at present, the inconsistent measurement protocols used in research are hindering translation into clinical practice. A minimum protocol for HRV evaluation, to be used in all studies involving epilepsy patients, is necessary to eventually allow HRV to become a useful tool for clinicians. We propose a straightforward protocol, involving 5-minute measurements of root mean square of successive differences in wakefulness and light sleep.

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Section: Interictal Hrv Patterns In Different Epilepsy Typesmentioning

confidence: 95%

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

2018

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“…Clinical and experimental studies have widely demonstrated that brain hypoxia-ischemia can induce seizures or epilepsy [ 16 , 17 , 18 , 19 , 20 ]. However, whether repetitive episodes of severe seizures as well as SE could induce chronic brain or systemic hypoxia-ischemia have been poorly investigated [ 21 , 22 ]. In this regard, one very complete experimental study confirmed the brain-heart connection in a model of SE induced by kainate.…”

Section: Introductionmentioning

confidence: 99%

Pilocarpine-Induced Status Epilepticus Is Associated with P-Glycoprotein Induction in Cardiomyocytes, Electrocardiographic Changes, and Sudden Death

et al. 2018

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Sudden unexpected death in epilepsy (SUDEP) is the major cause of death in those patients suffering from refractory epilepsy (RE), with a 24-fold higher risk relative to the normal population. SUDEP risk increases with seizure frequency and/or seizure-duration as in RE and Status Epilepticus (SE). P-glycoprotein (P-gp), the product of the multidrug resistant ABCB1-MDR-1 gene, is a detoxifying pump that extrudes drugs out of the cells and can confer pharmacoresistance to the expressing cells. Neurons and cardiomyocytes normally do not express P-gp, however, it is overexpressed in the brain of patients or in experimental models of RE and SE. P-gp was also detected after brain or cardiac hypoxia. We have previously demonstrated that repetitive pentylenetetrazole (PTZ)-induced seizures increase P-gp expression in the brain, which is associated with membrane depolarization in the hippocampus, and in the heart, which is associated with fatal SE. SE can produce hypoxic-ischemic altered cardiac rhythm (HIACR) and severe arrhythmias, and both are related with SUDEP. Here, we investigate whether SE induces the expression of hypoxia-inducible transcription factor (HIF)-1α and P-gp in cardiomyocytes, which is associated with altered heart rhythm, and if these changes are related with the spontaneous death rate. SE was induced in Wistar rats once a week for 3 weeks, by lithium-pilocarpine-paradigm. Electrocardiograms, HIF-1α, and P-gp expression in cardiomyocytes, were evaluated in basal conditions and 72 h after SE. All spontaneous deaths occurred 48 h after each SE was registered. We observed that repeated SE induced HIF-1α and P-gp expression in cardiomyocytes, electrocardiographic (ECG) changes, and a high rate of spontaneous death. Our results suggest that the highly accumulated burden of convulsive stress results in a hypoxic heart insult, where P-gp expression may play a depolarizing role in cardiomyocyte membranes and in the development of the ECG changes, such as QT interval prolongation, that could be related with SUDEP. We postulate that this mechanism could explain, in part, the higher SUDEP risk in patients with RE or SE.

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“…Patients with epilepsy may have troponin I value as high as 5.5 ng/mL and 6.3 ng/mL after generalized or temporal seizures [28,29], indicating some degree of ischemic myocardial injury due to sympathetic overactivity elicited by the generalized seizure [30,31]. An increase in mean serum levels of heart-type fatty acid-binding protein (H-FABP), a sensitive biomarker for myocardial ischemia, has been reported in children with intractable epilepsy either in the ictal or interictal periods [32], while in patients with known CAD myocardial infarction may follow an epileptic convulsive seizure [33].…”

Section: Discussionmentioning

confidence: 99%

Myocardial perfusion imaging single photon emission computed tomography may detect silent myocardial ischemia in patient with epilepsy

et al. 2022

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Background:The aim of the present study was to compare the myocardial perfusion imaging (MPI) with [ 99 mTc]tetrofosmin stress -rest single-photon emission computer tomography (SPECT) of patients with epilepsy with matched control individuals.Material and methods: All 29 adult epileptic patients were receiving antiepileptic drugs (AEDs) for epilepsy. Thirty-two individuals matched for gender and age consisted of the control group. MPIs SPECT were performed, and myocardial summed scores were obtained during stress (SSS) and rest (SRS) images. Abnormal MPI was considered when SSS was ≥ 4. In addition, the difference (SDS) between SSS and SRS was also assessed, which represents a rate of reversibility after stress.Results: Twenty of 29 (68.97%) patients with epilepsy had abnormal MPI and 14/32 (43.75%) of the controls (p = 0.04). Among males, 18/23 patients and 11/25 controls had abnormal MPI (p = 0.01), with quite a significant difference for mean SSS between male patients and controls (p = 0.002). Furthermore, SDS comparison showed that irreversible abnormalities were more common in patients than in control individuals. A difference of inadequately compensated myocardial ischemia between patients treated with enzyme inducing AEDs and patients treated with valproic acid was also detected.Conclusions: Single-photon emission computer tomography (SPECT) may detect increased risk for coronary artery disease and further cardiovascular events in patients with epilepsy. Our findings favor the conclusion that SPECT could be used for the early identification of cardiovascular comorbidity in epilepsy.

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

Cited by 7 publications

References 41 publications

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

Pilocarpine-Induced Status Epilepticus Is Associated with P-Glycoprotein Induction in Cardiomyocytes, Electrocardiographic Changes, and Sudden Death

Myocardial perfusion imaging single photon emission computed tomography may detect silent myocardial ischemia in patient with epilepsy

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