Cardiac Troponin (cTnI) Level and Myocardial Functions in Children with Idiopathic Convulsive Status Epilepticus

Abstract

Background: A Seizure represents the clinical expression of abnormal, excessive, synchronous discharges of neurons residing primarily in the cerebral cortex. The aim of this study is to evaluate the myocardial functions and serum cardiac troponin (cTn-I) in children with convulsive status epilepticus without evidence of previous cerebrovascular diseases. Methods: This study was a case control study which was carried out in the duration of 1 year from December 2021 to December 2022 in Tanta University Hospital, Pediatric Department, Intensive care unit (ICU) and the emergency room. The diagnosis of status epilepticus had been made in accordance with the criteria of the International League against Epilepsy clinically as a generalized seizure (epileptic seizure with duration more than 5 minutes or recurrent again without regaining consciousness in between seizures).  Another thirty (30) healthy children (16 males, 14 female) with age range from (3-15) years, with the mean age was (6.367±3.449) years, with no history of epilepsy or family history of neurological diseases, were enrolled in this study and were served as control group.  Inclusion criteria were no sex predilection, Patients with age of (3-15) years, and children with convulsive status epilepticus. Convulsion type with duration more than 5 minutes or recurrent again without regaining consciousness in between seizures. Results: There was significant increase in serum level of cardiac troponin cTn-I among children with idiopathic convulsive status epilepticus than healthy Control children, (P <0.001*). All patients with elevated serum levels cTn-I had documented ECG changes. The test result had a high positive predictive value which indicates high specificity of the of mean serum level of cardiac troponin test and that, Children have high probability of having myocardial ischemia and injury following attacks of idiopathic convulsive status epilepticus. Conclusions: Convulsive status epilepticus triggers severe physical activities, while skeletal muscle contraction increases the cardiac afterload in the tonic stage, leading to a transient imbalance in the cardiac tissue demand, which is associated with myocardial cell damage. Neural-hormonal factors contribute to myocardial cell damage (e.g., prolonged seizure activity that occurs in status epilepticus).