Department of Epileptology, University Hospital Bonn, Bonn, Germany.
Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria.
Epilepsia. 2019 Feb;60(2):201-210. doi: 10.1111/epi.14637. Epub 2019 Jan 15.
Generalized convulsive seizures (GCS) are associated with high demands on the cardiovascular system, thereby facilitating cardiac complications. To investigate occurrence, influencing factors, and extent of cardiac stress or injury, the alterations and time course of the latest generation of cardiac blood markers were investigated after documented GCS.
Adult patients with refractory epilepsy who underwent video-electroencephalography (EEG) monitoring along with simultaneous one-lead electrocardiography (ECG) recordings were included. Cardiac biomarkers (cardiac troponin I [cTNI]; high-sensitive troponin T [hsTNT]; N-terminal prohormone of brain natriuretic peptide [NT-proBNP]; copeptin; suppression of tumorigenicity-2 [SST-2]; growth differentiation factor 15, [GDF-15]; soluble urokinase plasminogen activator receptor [suPAR]; and heart-type fatty acid binding protein [HFABP]) and catecholamines were measured at inclusion and at different time points after GCS. Periictal cardiac properties were assessed by analyzing heart rate (HR), HR variability (HRV), and corrected QT intervals(QTc).
Thirty-six GCS (6 generalized-onset tonic-clonic seizures and 30 focal to bilateral tonic-clonic seizures) were recorded in 30 patients without a history of cardiac or renal disease. Postictal catecholamine levels were elevated more than twofold. A concomitant increase in HR and QTc, as well as a decrease in HRV, was observed. Elevations of cTNI and hsTNT were found in 3 of 30 patients (10%) and 6 of 23 patients (26%), respectively, which were associated with higher dopamine levels. Copeptin was increased considerably after most GCS, whereas SST-2, HFABP, and GDF-15 displayed only subtle variations, and suPAR was unaltered in the postictal period. Cardiac symptoms did not occur in any patient.
The use of more sensitive biomarkers such as hsTNT suggests that signs of cardiac stress occur in about 25% of the patients with GCS without apparent clinical symptoms. SuPAR may indicate clinically relevant troponin elevations. Copeptin could help to diagnose GCS, but specificity needs to be tested.
全身性强直阵挛发作（GCS）与心血管系统的高需求相关，从而促进了心脏并发症的发生。为了研究发作后的心脏应激或损伤的发生、影响因素和程度，我们研究了最新一代心脏血液标志物的变化和时间过程。
纳入了接受视频脑电图（EEG）监测并同时进行单导联心电图（ECG）记录的难治性癫痫成年患者。在纳入时以及 GCS 后不同时间点测量了心脏生物标志物（心肌肌钙蛋白 I [cTNI]；高敏肌钙蛋白 T [hsTNT]；脑利钠肽前体 N 末端 [NT-proBNP]；copeptin；抑制肿瘤生成素 2 [SST-2]；生长分化因子 15，[GDF-15]；可溶性尿激酶型纤溶酶原激活物受体 [suPAR]；和心脏型脂肪酸结合蛋白 [HFABP]）和儿茶酚胺。通过分析心率（HR）、心率变异性（HRV）和校正 QT 间期（QTc）来评估发作间期的心脏特性。
在没有心脏或肾脏疾病病史的 30 名患者中记录了 36 次 GCS（6 次全面强直阵挛发作和 30 次局灶性双侧强直阵挛发作）。发作后儿茶酚胺水平升高了两倍以上。观察到 HR 和 QTc 升高，HRV 降低。在 30 名患者中的 3 名（10%）和 23 名患者中的 6 名（26%）中发现 cTNI 和 hsTNT 升高，这与较高的多巴胺水平相关。copeptin 在大多数 GCS 后明显升高，而 SST-2、HFABP 和 GDF-15 仅显示出轻微的变化，suPAR 在发作后没有变化。任何患者均未出现心脏症状。
使用 hsTNT 等更敏感的生物标志物表明，大约 25%的 GCS 患者没有明显的临床症状，但存在心脏应激迹象。suPAR 可能提示临床上相关的肌钙蛋白升高。copeptin 可帮助诊断 GCS，但需要测试其特异性。
