Association of cardiovascular risk factors and troponin elevation after generalized tonic-clonic seizures

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.

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.

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).

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.