title: Association of cardiovascular risk factors and troponin elevation after generalized tonic-clonic seizures.
abstract: OBJECTIVE
  Troponins are very sensitive biomarkers of myocardial injury. Conflicting data regarding elevation of troponin levels following a generalized tonic-clonic (GTC) seizure have been reported. In this study we hypothesized that troponin elevation after a GTC seizure occurs more frequently in patients with cardiovascular risk factors.
  
  
  METHODS
  Patients who presented to the ER after a single GTC seizure with troponin levels assessed by cardiac troponin T (cTnT) and drawn within 12h of the GTC seizure were included. Patients with cardiac symptoms, elevated CPK levels or renal insufficiency were excluded. The frequency and risk factors for elevated cTnT levels were analyzed.
  
  
  RESULTS
  Fourteen patients with a mean age of 54 years (range: 19-87 years) were included. Four patients (28.6%) had elevated cTnT levels (mean=0.06μg/L; range: 0.035-0.076μg/L). Patients with elevated cTnT levels were significantly older than those with normal levels (77.5 years vs. 45.5 years; P=0.03). Of the eight patients 60 years of age and older, four (50%) had elevated cTnT levels. The coronary heart disease (CHD) score was significantly higher in patients with elevated cTnT levels compared to those with normal levels (13.5 vs. 9.75, P=0.012).
  
  
  CONCLUSIONS
  Elevated troponin levels can occur after a GTC seizure. Patients at risk are the elderly and those with cardiovascular risk factors. Our results suggest that elevation of troponin levels after a GTC seizure reflects a minor ischemic cardiac injury related to the demand ischemia during the sympathetic overactivity that accompanies a GTC seizure.
authors: Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: af25@aub.edu.lb.
authors: Ahmad
authors: A
authors: Fawaz
authors: Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: wn13@aub.edu.lb.
authors: Wassim
authors: W
authors: Nasreddine
authors: Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ymakke@gmail.com.
authors: Yamane
authors: Y
authors: Makke
authors: Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: sfatweh@aub.edu.lb.
authors: Samir
authors: S
authors: Atweh
authors: Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: jaafar.wazne@hotmail.com.
authors: Jaafar
authors: J
authors: Wazne
authors: Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: maher_arabi@hotmail.com.
authors: Maher
authors: M
authors: Arabi
authors: Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ab29@aub.edu.lb.
authors: Ahmad
authors: A
authors: Beydoun
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications*; D002561:Cerebrovascular Disorders / Q000097:blood / Q000150:complications; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012640:Seizures / Q000150:complications*; D012720:Severity of Illness Index; D014336:Troponin / Q000097:blood*; D020107:Troponin T / Q000097:blood*; D055815:Young Adult
chemical_list: D014336:Troponin; D020107:Troponin T
keywords: Cardiovascular risk factors; Epilepsy; Generalized tonic-clonic seizure; Myocardial ischemia; Troponin