Takotsubo Cardiomyopathy in Epilepsy: A Systematic insight into the Existing Literature from 2000-2023

Abstract

Background & Objective: Takotsubo cardiomyopathy (TCM), manifests as left ventricular dysfunction triggered by physical or emotional stress. It leads to higher morbidity in epileptic patients and can progress to complications. To find out the correlation between Takotsubo cardiomyopathy and epilepsy and to investigate pathophysiology and associated types of epilepsy.

Methodology: This systematic review adhered to PRISMA guidelines and was sourced from the PubMed Central database. Search terms were pertinent to cardiomyopathy and epilepsy. Sixteen studies, comprising case reports and a case series were selected from 2000 to 2023 for data extraction. The quality evaluation was executed via the Joanna Briggs Institute Critical Appraisal checklist.

Results: The review included 18 female patients with a mean age of 57.22 years. Predominant symptoms included tonic-clonic seizures (66.66%). Seizure-induced TCM pathophysiology implicates catecholamine surge, precipitating myocardial stunting and characteristic apical ballooning. Most patients had a history of epilepsy (38.88%). ECG findings showed tachycardia (38.88%) and ST-segment elevation (38.88%). Elevated troponin levels were noted in 83.33% of patients. Echocardiography showed reduced ejection fraction (72.22%), hypokinesia (38.88%) and akinesis (27.77%). Treatment involved Benzodiazepines (50%), Beta-blockers (61.11%) and Phenytoin (38.88%). The majority of patients showed improvement in echocardiography findings (55.55%) and ECG findings (11.11%).

Conclusion: TCM in epilepsy patients evinces significant female predominance, with pathophysiology rooted in seizure-induced catecholamine surge. Early recognition in high-risk patients is essential in preventing complications.

doi: https://doi.org/10.12669/pjms.40.12(PINS).11274

How to cite this: Qadri HM, Ismail F, Khawaja M, Sohail A, Bukhari S, Bashir A. Takotsubo Cardiomyopathy in Epilepsy: A Systematic insight into the Existing Literature from 2000-2023. Pak J Med Sci. 2024;40(12):S114-S125. doi: https://doi.org/10.12669/pjms.40.12(PINS).11274

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