Abstracts

Rationale: Incidence of sudden unexpected death in epilepsy (SUDEP) is 24 times higher than in age matched controls. Multiple risk factors are duration of epilepsy, generalized seizures, cumulative effect of seizures overtime, poor seizure control and multiple anti-epileptic drugs. Possible mechanisms include arrhythmias, increased myocardial oxygen consumption, excess catecholamine release during seizures and effect of AEDs on cardiac rhythm. Cardiac biomarkers (Troponin I, CK-MB and pro-BNP) are sensitive for myocardial damage, and if positive may help in detection of such patients at risk for SUDEP. Our objective was to see presence of ongoing myocardial damage in patients who attended epilepsy clinic. Methods: We evaluated 65 consecutive patients who presented at Epilepsy Clinic, National Neuroscience Institute at King Fahad Medical City. Cardiac Biomarkers (Troponin I, CK-MB and pro-BNP) and EKG were requested in all patients. The questionnaire used for interview consisted of demographic details, disease related parameters (duration of epilepsy, seizure frequency, number of antiepileptic drugs, compliance to treatment), history of cardiac disease, peri-ictal heart related symptoms. Results: Thirty nine out of 65 patients were included in the study. The excluded patient did not consent to investigations. There were 18 females and 21 males, with mean age (+ SD) of 28.2 (+ 12.1) years. Average duration of epilepsy was 118 (+110) months with mean seizure frequency of 1-3 per year. Except for 1 patient, all were on AEDs (range 0-3 drugs/patient). All but 3 patients were complaint to the treatment. Mean biomarker levels were; Troponin I = 0.01( + 0.01), proBNP = 4.3 (+ 5.06), and CK-MB = 1.1 (+ 0.81). Peri-ictal symptoms were documented in 7 patients and were shortness of breath, chest pain and palpitation. Abnormal EKGs were found in 11 (28%) patients (2 had bradycardia, prolong QT interval, T wave abnormalities, and left ventricular hypertrophy each; 1 each with short PR interval, fusion complexes and right bundle branch block. No correlation was seen between biomarkers and EKG, or with other clinical/ demographic variables. Conclusions: There was no detectable ongoing myocardial damage seen in patients who attended epilepsy clinic. Nonspecific EKG abnormalities were seen in 28% patient that needs further study.