| Objectives: To investigate the changes of serum monoamine neurotransmitters and myocardial enzymes in patients with refractory epilepsy,and the possible effects on the cardiovascular system,which would contribute to provide help and guidance to the early warming and prevention to the sudden unexpected death in epilepsy(SUDEP).Methods: Collected sixty patients with refractory epilepsy admitted to Neurological department of First Hospital of Jilin University from December 2015 to December 2016.According to the exclusion criteria,we selected thirty-two patients into the study.The study included 21 males and 11 females patients.5ml venous blood were collected from the same patient in peri ictal period(within 30 min after the onset)and interictal period,and then were placed in the coagulation tube.The serum was taken out after 10 minutes with 3000 r / min centrifugal.Then we put it into-80 ? refrigerator.Epinephrin(EPI),norepinephrine(NE),dopamine(DA),5-hydroxytryptamine(5-HT),Creatine kinase isoenzyme(CKMB),lactate dehydrogenase(LDH)and hydroxybutyrate dehydrogenase(HBDH)were measured in ictal period and the interictal period in the patients with refractory epilepsy.The results were compared between groups.All the data were analyzed by SPSS17.0 statistical software,and the difference was statistically significant at P <0.05.Results:(1)A total of 60 patients with RE were collected.All patients were treated with two or more antiepileptic drugs,combined with history,imaging and electroencephalogram(EEG),in line with the diagnosis of refractory epilepsy.After screening,32 patients were eligible,21 males(65.6%),11 females(34.4%);The age ranged from 15 to 85 years old.The average age was 50.9±17.6 years old.12(37.5%)were older than 60 years old and 20(62.5%)were under 60 years old.The epilepsy history ranged from 1 year to 14 years,and had an average of 3.75±3.12 years.The type of epilepsy included GTCS(8 patients)and s GTC(24 patients).(2)Comparing the levels of monoamine neurotransmitters in ictal period and the interictal period in the patients with refractory epilepsy,we found that the level of EPI was significantly lower than that in interictal period,while the levels of NE and DA were significantly increased(P<0.05).5-HT level showed no statistical changes.(3)There is no significant difference in the levels of CKMB and HBDH in the patients with refractory epilepsy compared with the interictal period.(4)The results showed that LDH and HBDH in females were significantly higher than those of males,but there was no statistically significant difference between males and females in monoamine neurotransmitters and CKMB.(5)The results showed that EPI,NE and DA levels in refractory patients under 60 were higher than the other group.There was a statistically significant difference between two groups(P<0.05).(6)Patients were divided into four groups according to the etiology of the disease.10 patients(31.25%)were included in the idiopathic epilepsy group,7 patients(21.88%)post-encephalitic epilepsy,9 patients(28.12%)with post-stroke epilepsy,6 patients(18.75%)with epilepsy after brain injury.The results showed that the levels of EPI,NE and DA in the epilepsy group were significantly lower than those in the other three groups(P<0.05).The level of CKMB in the idiopathic epilepsy group was higher than that in post-stroke epilepsy and epilepsy induced by brain injury.There was no statistical difference between the two groups with other datum.(6)32 patients underwent brain CT and / or brain MRI examination.About 17 patients(53.12%)showed changes,which mainly presented with softening,low density in brain CT and abnormal high signals in brain MRI can.The left 15 patients(46.88%)had no much imaging changes.The results showed that the levels of EPI,NE,DA and CKMB in patients with refractory epilepsy were significantly lower than those without radiographic changes,and there was significant difference between the two groups.There was no statistically significant difference in the level of 5-HT,LDH and HBDH.(7)EEG were performed on 32 patients.According to the abnormal discharge location,all patients were divided into three groups,of which 8 patients(25%)showed bilateral abnormal discharges,10 patients(31.25%)showed left abnormal discharges,and 14 patients(43.75%)presented with the right side.The results showed that the level of EPI and CKMB in the bilateral abnormal discharge group was higher than that in the left group.The level of CKMB and HBDH in the bilateral abnormal discharge group was higher than that in the right group.The level of NE in the left group was higher than that in the right group and showed statistical differences.(8)There were 20 patients(62.5%)with status epilepticus(SE)and 12 patients(37.5%)without it.While the levels of myocardial enzymes in patients with epilepsy status were lower than those without status epilepticus(P <0.05).There was no significant difference between the two groups about other datum(P> 0.05).Conclusions:(1)Refractory epilepsy patients with peri-ictal serum norepinephrine,dopamine content than the episodes increased,suggesting that seizures may increase sympathetic nervous excitability.(2)Women with RE may be more likely to increase myocardial enzymes after seizures than men.(3)Younger patients(aged < 60 years)with refractory epilepsy release more catecholamines than the older(aged > 60 years),suggesting that young patients with intractable epilepsy may have higher sympathetic nerve excitability.And it may be associated with the higher incidence of SUDEP in young patients.(4)Different etiologies of epilepsy had different levels of monoamine neurotransmitter and myocardial enzyme,post-stroke epilepsy release less catecholamine than others,suggesting that the sympathetic nervous excitability is relatively low,and it may have relatively little damage to heart.(5)Patients with a SE history may release more epinephrine,suggesting that SE may increase the sympathetic nervous excitability. |
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