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Xia Y, Lai W, Sha L, Duan Y, Chen L. Causal link between oxidative stress and epilepsy: A two-sample Mendelian randomization study. Brain Behav 2024; 14:e3549. [PMID: 38849979 PMCID: PMC11161392 DOI: 10.1002/brb3.3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Although a growing body of research has indicated a strong link between oxidative stress and epilepsy, the exact nature of their interaction remains elusive. To elucidate this intricate relationship, we conducted a bidirectional Mendelian randomization (MR) analysis employing two independent datasets. METHODS A two-sample MR analysis was performed using instrumental variables derived from genome-wide association study summary statistics of oxidative stress injury biomarkers (OSIB) and epilepsy. The OSIBs were selected from eight primary metabolic pathways associated with oxidative stress. Additionally, seven distinct epilepsy phenotypes were considered, which encompassed all epilepsy, generalized epilepsy, generalized tonic-clonic seizures, focal epilepsy, focal epilepsy with hippocampal sclerosis (focal HS), focal epilepsy with lesions other than HS (focal NHS), and lesion-negative focal epilepsy. Causal estimates were computed using the inverse-variance weighted method or the Wald ratio method, and the robustness of causality was assessed through sensitivity analyses. RESULTS For OSIB and epilepsy, 520 and 23 genetic variants, respectively, were selectively extracted as instrumental variants. Genetically predicted higher kynurenine level was associated with a decreased risk of focal epilepsy (odds ratio [OR] 1.950, 95% CI 1.373-2.528, p = .023) and focal NHS (OR 1.276, 95% CI 1.100-1.453, p = .006). For reverse analysis, there was a suggestive effect of focal NHS on urate (OR 1.19 × 1015, 95% CI 11.19 × 1015 to 1.19 × 1015, p = .0000746) and total bilirubin (Tb) (OR 4.98, 95% CI 3.423-6.543, p = .044). In addition, genetic predisposition to focal HS was associated with higher Tb levels (OR 9.83, 95% CI 7.77-11.888, p = .034). CONCLUSION This MR study provides compelling evidence of a robust association between oxidative stress and epilepsy, with a notable emphasis on a causal relationship between oxidative stress and focal epilepsy. Additional research is warranted to confirm the connection between oxidative stress and the risk of epilepsy and to unravel the underlying mechanisms.
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Affiliation(s)
- Yilin Xia
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Wanlin Lai
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Leihao Sha
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Yifei Duan
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Lei Chen
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
- Pazhou LabGuangzhouChina
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Ansari AG, Zafar L, Khan R, Nasar A. Determinants of Outcomes in Convulsive Status Epilepticus: An Observational Study at a Tertiary Care Center in North India. Cureus 2024; 16:e60017. [PMID: 38854345 PMCID: PMC11162821 DOI: 10.7759/cureus.60017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Objective Status epilepticus (SE) presents a critical neurological emergency associated with high morbidity and mortality rates worldwide. However, the determinants influencing outcomes in SE within specific regional contexts remain less explored, especially within North India. Understanding the factors influencing the prognosis of SE in this region is crucial for tailored therapeutic approaches and improved patient outcomes. Materials and methods This observational study was conducted at Jawaharlal Nehru Medical College, Aligarh, India, from December 1, 2020, to November 31, 2022. Patients who presented with convulsive SE lasting more than five minutes or repetitive and discrete seizures with impaired consciousness between the interictal period for at least 30 minutes were included in the study. Their clinical and biochemical variables at presentation were assessed and correlated with the outcome. Results Out of the 110 patients included in the study, males represented 59.1% (n=65), outnumbering females, who comprised 40.9% (n=45). Favourable outcome was observed in 66.36% (n=73) of patients, and unfavourable outcome was observed in 33.63% (n=37). The mean time interval between seizure onset to the patient's arrival at the hospital was 5.30 ± 4.96 hours, and the mean time interval between seizure onset to the point of seizure control was 7.10 ± 6.38 hours. On analysing the factors associated with unfavourable outcome, the type of seizure at onset (p=0.021), Glasgow Coma Scale (GCS) of <=12 at presentation (p<0.001), presence of refractory seizure (p<0.001), presence of abnormal epileptiform discharges on electroencephalography (p=0.001), Status Epilepticus Severity Score (STESS) of >2 (p<0.001), serum lactate levels (p<0.001), duration of hospital stay (p=0.004), time interval between seizure onset to hospital arrival (p<0.001) and time interval between seizure onset to the point of seizure control (p<0.001) showed significant association. However, on analysing the independent risk factors of unfavourable outcome using multivariate logistic regression, only duration of hospital stay (p<0.001, odds ratio (OR): 1.205, 95% confidence interval (CI): 1.046-1.389), and GCS of less than or equal to 12 at presentation (p<0.001, OR: 12.354, 95% CI: 2.974-51.319) showed significant association. Conclusions Our study highlighted key clinical and time-related parameters influencing the outcome of convulsive SE. Understanding these factors is crucial for better treatment and improved patient outcomes. Further research is essential for refining interventions in this complex condition.
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Affiliation(s)
- Ahmad G Ansari
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Lubna Zafar
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Ruhi Khan
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Ariba Nasar
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
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Chegodaev DA, Pavlova PA. High lactic acid levels in the brain contribute to the generation of focal slowing on the electroencephalogram. Front Neurol 2024; 15:1393274. [PMID: 38694777 PMCID: PMC11061411 DOI: 10.3389/fneur.2024.1393274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/09/2024] [Indexed: 05/04/2024] Open
Abstract
Focal slowing on the EEG is often associated with structural pathology of the brain. Despite the clinical significance of focal slowing, the actual electrochemical mechanisms underlying this EEG phenomenon are still poorly understood. This paper briefly reviews the role of lactate in the pathogenesis of brain disorders that are primarily related to focal EEG slowing. An attempt is made to trace the hypothetical link between this EEG pattern and focal cerebral tissue lactacidosis.
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Affiliation(s)
- Dmitry Alexandrovich Chegodaev
- Laboratory for Brain and Neurocognitive Development, Ural Institute of Humanities, Ural Federal University named after the First President of Russia B. N. Yeltsin, Yekaterinburg, Russia
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Bekbolatova M, Mayer J, Jose R, Syed F, Kurgansky G, Singh P, Pao R, Zaw H, Devine T, Chan-Akeley R, Toma M. Biomechanical Effects of Seizures on Cerebral Dynamics and Brain Stress. Brain Sci 2024; 14:323. [PMID: 38671975 PMCID: PMC11048267 DOI: 10.3390/brainsci14040323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Epilepsy is one of the most common neurological disorders globally, affecting about 50 million people, with nearly 80% of those affected residing in low- and middle-income countries. It is characterized by recurrent seizures that result from abnormal electrical brain activity, with seizures varying widely in manifestation. The exploration of the biomechanical effects that seizures have on brain dynamics and stress levels is relevant for the development of more effective treatments and protective strategies. This study uses a blend of experimental data and computational simulations to assess the brain's physical response during seizures, particularly focusing on the behavior of cerebrospinal fluid and the resulting mechanical stresses on different brain regions. Notable findings show increases in stress, predominantly in the posterior gyri and brainstem, during seizures and an evidence of brain displacement relative to the skull. These observations suggest a dynamic and complex interaction between the brain and skull, with maximum shear stress regions demonstrating the limited yet essential protective role of the CSF. By providing a deeper understanding of the mechanical changes occurring during seizures, this research supports the goal of advancing diagnostic tools, informing more targeted treatment interventions, and guiding the creation of customized therapeutic strategies to enhance neurological care and protect against the adverse effects of seizures.
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Affiliation(s)
- Molly Bekbolatova
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA; (M.B.); (J.M.); (R.J.); (F.S.); (G.K.); (P.S.)
| | - Jonathan Mayer
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA; (M.B.); (J.M.); (R.J.); (F.S.); (G.K.); (P.S.)
| | - Rejath Jose
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA; (M.B.); (J.M.); (R.J.); (F.S.); (G.K.); (P.S.)
| | - Faiz Syed
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA; (M.B.); (J.M.); (R.J.); (F.S.); (G.K.); (P.S.)
| | - Gregory Kurgansky
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA; (M.B.); (J.M.); (R.J.); (F.S.); (G.K.); (P.S.)
| | - Paramvir Singh
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA; (M.B.); (J.M.); (R.J.); (F.S.); (G.K.); (P.S.)
| | - Rachel Pao
- NewYork-Presbyterian Queens Hospital, New York City, NY 11355, USA;
| | - Honey Zaw
- Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, Atran Berg Building, 8th Floor, New York City, NY 10029, USA;
| | - Timothy Devine
- The Ferrara Center for Patient Safety and Clinical Simulation, Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA;
| | | | - Milan Toma
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA; (M.B.); (J.M.); (R.J.); (F.S.); (G.K.); (P.S.)
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Akel S, Banote RK, Asztely F, Zelano J. Protein profiling in plasma for biomarkers of seizure. Epilepsy Res 2023; 197:107241. [PMID: 37862918 DOI: 10.1016/j.eplepsyres.2023.107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE A biochemical way to measure seizures would greatly benefit epilepsy research and clinical follow-up. Short-term biomarkers like lactate exist, and interest in biomarkers representative of longer-term seizure burden is growing. In this exploratory study, we aimed to identify markers in blood plasma that differentiate persons with recent seizures from persons with epilepsy and long-standing seizure freedom. METHODS A proteomic analysis was performed on plasma samples of 120 persons with seizures using the Olink Neuro-exploratory panel. Participants were selected from a regional biobank study in Västra Götaland (Sweden) and categorized into two groups: recent seizure and seizure-free. The panel contained 92 proteins linked to neurological diseases and processes, and levels of these proteins were compared between the patient groups to identify potential markers of seizure activity. RESULTS We identified significant differences in protein levels between the recent seizure and seizure-free patient groups for Cadherin-15 [(CDH15; p = 0.008)], Latent transforming growth factor beta-binding protein 3 [(LTBP3; p = 0.002)], Phosphoethanolamine/phosphocholine phosphatase 1 [(PHOSPHO1; p = 0.011)], and Progestagen associated endometrial protein [(PAEP; p = 0.0005)]. CONCLUSION The findings in this study present CDH15, LTBP3, PHOSPHO1 and PAEP as candidate markers of seizure activity. Further confirmatory studies are needed.
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Affiliation(s)
- Sarah Akel
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Rakesh Kumar Banote
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Asztely
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Abdelnaby R, Elgenidy A, Heckelmann J, Bedewy MM, Shabib AS, Ebrahim MA, Elmenawi KA, Maallem I, Youssef MW, Attia AM, Moawad MH, Mohamed KA, Gaballa A. The role of creatine kinase in distinguishing generalized tonic-clonic seizures from psychogenic non-epileptic seizures (PNES) and syncope: a retrospective study and meta-analysis of 1300 patients. Neurol Res Pract 2023; 5:56. [PMID: 37821955 PMCID: PMC10568853 DOI: 10.1186/s42466-023-00286-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND/AIM As the clinical differentiation between epileptic seizures, psychogenic non-epileptic seizures (PNES), and syncope depends mainly on a detailed report of the event, which may not be available, an objective assessment of a potential biochemical analysis is needed. We aimed to investigate whether serum creatine kinase (CK) could be used to differentiate epileptic seizure from PNES and syncope and to assess the strength of evidence present. METHODS We directed a retrospective cohort study coupled with a systematic review and meta-analysis of studies that measured CK in patients with epilepsy, PNES, syncope, and healthy controls. RESULTS The cohort study, which traced 202 patients, showed that the CK level was significantly higher 48 h after the event in the epilepsy group versus patients with syncope (p < 0.01) Along with 1086 patients obtained through a database search for meta-analysis, CK level compared to different types of seizures from PNES was higher in epileptic seizure patients with a mean difference of 568.966 mIU/ml (95% CI 166.864, 971.067). The subgroup analysis of CK showed that it was higher in GTCS compared to syncope with a mean difference of 125.39 mIU/ml (95% CI 45.25, 205.52). DISCUSSION Increased serum levels of CK have been associated mainly with epileptic seizures in relation to non-epileptic events. However, further studies would try to explore the variation in measurements and any other potential diagnostic marker. CONCLUSION The cohort study shows that the CK level in epilepsy seizures is higher after 48 h from the event compared to syncope. Moreover, the meta-analysis results show the present diagnostic utility of CK and its importance to be used in accordance with a detailed report of the event.
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Affiliation(s)
- Ramy Abdelnaby
- Department of Neurology, RWTH Aachen University, Aachen, Germany.
| | | | - Jan Heckelmann
- Department of Neurology, RWTH Aachen University, Aachen, Germany
| | | | | | | | | | - Imene Maallem
- Faculté de Pharmacie, 23 Avenue Maquis du Grésivaudan, 38700, La Tronche, Grenoble, France
| | | | | | - Mostafa Hossam Moawad
- Faculty of Pharmacy, Clinical Department, Alexandria University, Alexandria, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Ahmed Gaballa
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Campus Bielefeld- Bethel, Bielefeld, Germany
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Goldman M, Lucke-Wold B, Katz J, Dawoud B, Dagra A. Respiratory Patterns in Neurological Injury, Pathophysiology, Ventilation Management, and Future Innovations: A Systematic Review. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2023; 8:338-349. [PMID: 38130817 PMCID: PMC10735242 DOI: 10.14218/erhm.2022.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traumatic brain injuries (TBI), ischemic stroke, hemorrhagic stroke, brain tumors, and seizures have diverse and sometimes overlapping associated breathing patterns. Homeostatic mechanisms for respiratory control are intertwined with complex neurocircuitry, both centrally and peripherally. This paper summarizes the neurorespiratory control and pathophysiology of its disruption. It also reviews the clinical presentation, ventilatory management, and emerging therapeutics. This review additionally serves to update all recent preclinical and clinical research regarding the spectrum of respiratory dysfunction. Having a solid pathophysiological foundation of disruptive mechanisms would permit further therapeutic development. This novel review bridges experimental/physiological data with bedside management, thus allowing neurosurgeons and intensivists alike to rapidly diagnose and treat respiratory sequelae of acute brain injury.
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Affiliation(s)
| | | | | | - Bavly Dawoud
- Neurosurgical Resident, University of Illinois, Peoria Illinois, United States
| | - Abeer Dagra
- Research Assistant, University of Florida, Gainesville, United States
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Coutinho MP, Faustino P, Ladeira F, Leitão L. Hypophosphatemia as a possible biomarker for epileptic seizures at the emergency department. Seizure 2023; 111:42-44. [PMID: 37506565 DOI: 10.1016/j.seizure.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/25/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Hypophosphatemia seems to be temporally associated with seizures, despite not being considered a trigger. We aimed to evaluate hypophosphatemia as a biomarker for seizures. METHODS Retrospective study, including all consecutive patients admitted at our central hospital's emergency department from 01/01-31/03/2021, screened as "altered consciousness/syncope" or "seizures", with available phosphate levels. RESULTS 277 patients included, mostly male (61.7%), mean age 64.3 years. Final diagnosis was "seizure" in 34.7% and "other diagnosis" in 65.3%. Patients with seizures were younger (p<0.001), had more frequent epilepsy (p<0.001) and alcoholism (p=0.01). Patients with other diagnosis had more often renal failure (p<0.001) and statin (p=0.02) or diuretic (p=0.003) therapy. Time to blood collection (from the event and from admission) was similar between groups. Patients with seizures had lower mean phosphate levels and more frequent hypophosphatemia (<2.4mg/dL) (p<0.001). Mean CK levels were similar in both groups (p=0.25). HyperCK (>200U/L) was more frequent in the seizure group (p=0.04). Odds ratio (OR) of hypophosphatemia for seizures was 4.330 (CI 95% 2.170-8.640, p<0.001), persisting after correction for confounders. OR of hyperCK was 1.890 (CI 95% 1.060-3.371, p=0.03), losing significance when adjusted. Sensitivity was low for both. Hypophosphatemia was more specific (91.2% vs 79.9%). CONCLUSIONS Our findings support hypophosphatemia as a seizure biomarker. More studies are needed.
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Affiliation(s)
- Maria P Coutinho
- Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
| | | | - Filipa Ladeira
- Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Lia Leitão
- Hospital Fernando da Fonseca, Amadora, Portugal
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Uematsu K, Matsumoto H, Zaha K, Mizuguchi M, Nonoyama S. Prediction and assessment of acute encephalopathy syndromes immediately after febrile status epilepticus. Brain Dev 2023; 45:93-101. [PMID: 36328834 DOI: 10.1016/j.braindev.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to predict occurrence of acute encephalopathy syndromes (AES) immediately after febrile status epilepticus in children and to explore the usefulness of electroencephalogram (EEG) in the early diagnosis of AES. METHODS We reviewed data from 120 children who had febrile status epilepticus lasting >30 min and were admitted to our hospital between 2012 and 2019. AES with reduced diffusion on brain magnetic resonance imaging was diagnosed in 11 of these patients. EEG and serum cytokines were analyzed in AES patients. Clinical symptoms and laboratory data were compared between AES and non-AES patients. Logistic regression analysis was used to identify early predictors of AES. RESULTS Multivariate logistic regression identified serum creatinine as a risk factor for developing AES. A scoring model to predict AES in the post-ictal phase that included serum creatinine, sodium, aspartate aminotransferase, and glucose was developed, and a score of 2 or more predicted AES with sensitivity of 90.9% and specificity of 71.6%. Post-ictus EEG revealed non-convulsive status epilepticus in four of the seven AES patients. CONCLUSION Children with febrile status epilepticus may be at risk of developing severe AES with reduced diffusion. Post-ictus EEG and laboratory data can predict the occurrence of severe AES.
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Affiliation(s)
- Kenji Uematsu
- Department of Pediatrics, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroshi Matsumoto
- Department of Pediatrics, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
| | - Kiyotaka Zaha
- Department of Pediatrics, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Masashi Mizuguchi
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, 1-1-10 Komone, Itabashi-ku, Tokyo, Japan
| | - Shigeaki Nonoyama
- Department of Pediatrics, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
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Kelmer E, Ohad DG, Shamir MH, Chai O, Lavie S, Sutton GA, Aroch I, Klainbart S. The diagnostic utility of hypophosphatemia for differentiating generalized tonic-clonic seizures from syncope in dogs: A case control study. Vet J 2023; 291:105914. [PMID: 36220539 DOI: 10.1016/j.tvjl.2022.105914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 12/24/2022]
Abstract
Transient hypophosphatemia is often detected in humans following generalized tonic-clonic seizures (GTCS), and serum phosphorus concentration (sPi) serves as a marker to differentiate GTCS from syncope. The objective of this retrospective study was to assess the usefulness of hypophosphatemia as a diagnostic marker for GTCS in dogs. Eighty-seven and 26 client-owned dogs with GTCS or syncope, respectively, were enrolled. Dogs were included if the episode occurred ≤ 3 h from presentation, and if sPi and serum creatinine (sCr) were measured. Dogs were excluded if aged < 1 year or if sCr exceeded 176.8 μmol/L. There were no group differences in sCr. Hypophosphatemia (sPi ≤ 0.97 mmol/L) occurred in 28 dogs (32%) in the seizure group, and in no dogs in the syncope group. Median sPi was significantly (P < 0.001) lower in the seizure group (1 mmol/L, [range, 0.31-2.87 mmol/L]) compared to the syncope group (1.35 mmol/L [range, 0.97-2.71 mmol/L]). Furthermore, in dogs presented while seizing (n = 24/87; 28%) median sPi was significantly lower compared to those that were not (0.9 mmol/L [range, 0.3-1.74 mmol/L] vs. 1 mmol/L [range, 0.33-2.18 mmol/L], P = 0.050). ROC analysis of sPi as a marker of GTCS yielded an AUC of 0.757 (95% confidence interval 0.667-0.847), with an optimum cutoff point of 0.97 mmol/L, corresponding to specificity and sensitivity levels of 100% and 44%, respectively. In conclusion, sPi may, in certain cases, serve as an additional diagnostic tool to differentiate GTCS from syncope in dogs. Hypophosphatemia, especially with sPi < 0.97 mmol/L, may be useful in clinical practice to rule in GTCS.
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Affiliation(s)
- E Kelmer
- The Hebrew University Veterinary Teaching Hospital, the Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, P.O. Box 12, Rehovot 76100, Israel.
| | - D G Ohad
- The Hebrew University Veterinary Teaching Hospital, the Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, P.O. Box 12, Rehovot 76100, Israel
| | - M H Shamir
- The Hebrew University Veterinary Teaching Hospital, the Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, P.O. Box 12, Rehovot 76100, Israel
| | - O Chai
- The Hebrew University Veterinary Teaching Hospital, the Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, P.O. Box 12, Rehovot 76100, Israel
| | - S Lavie
- The Hebrew University Veterinary Teaching Hospital, the Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, P.O. Box 12, Rehovot 76100, Israel
| | - G A Sutton
- The Hebrew University Veterinary Teaching Hospital, the Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, P.O. Box 12, Rehovot 76100, Israel
| | - I Aroch
- The Hebrew University Veterinary Teaching Hospital, the Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, P.O. Box 12, Rehovot 76100, Israel
| | - S Klainbart
- The Hebrew University Veterinary Teaching Hospital, the Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, P.O. Box 12, Rehovot 76100, Israel
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Patel J, Tran QK, Martinez S, Wright H, Pourmand A. Utility of serum lactate on differential diagnosis of seizure-like activity: A systematic review and meta-analysis. Seizure 2022; 102:134-142. [DOI: 10.1016/j.seizure.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 10/31/2022] Open
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12
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Pańczyk‐Straszak K, Rapacz A, Marona H, Żelaszczyk D, Karczewska E, Zając M, Skiba‐Kurek I, Siwek A, Waszkielewicz A. Design, Synthesis and Anticonvulsant Activity of New Phenoxyalkyl, Phenoxyethoxyethyl and Phenoxyacetyl Derivatives of Aminoalkanols. ChemistrySelect 2022. [DOI: 10.1002/slct.202201233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Katarzyna Pańczyk‐Straszak
- Jagiellonian University Medical College Faculty of Pharmacy Chair of Organic Chemistry Department of Bioorganic Chemistry Medyczna 9 30-688 Kraków Poland
| | - Anna Rapacz
- Jagiellonian University Medical College Faculty of Pharmacy Department of Pharmacodynamics Medyczna 9 30-688 Kraków Poland
| | - Henryk Marona
- Jagiellonian University Medical College Faculty of Pharmacy Chair of Organic Chemistry Department of Bioorganic Chemistry Medyczna 9 30-688 Kraków Poland
| | - Dorota Żelaszczyk
- Jagiellonian University Medical College Faculty of Pharmacy Chair of Organic Chemistry Department of Bioorganic Chemistry Medyczna 9 30-688 Kraków Poland
| | - Elżbieta Karczewska
- Jagiellonian University Medical College Faculty of Pharmacy Department of Pharmaceutical Microbiology Medyczna 9 30-688 Kraków Poland
| | - Martyna Zając
- Jagiellonian University Medical College Faculty of Pharmacy Medyczna 9 30-688 Kraków Poland
| | - Iwona Skiba‐Kurek
- Jagiellonian University Medical College Faculty of Pharmacy Department of Pharmaceutical Microbiology Medyczna 9 30-688 Kraków Poland
| | - Agata Siwek
- Jagiellonian University Medical College Faculty of Pharmacy Department of Pharmacobiology Medyczna 9 30-688 Kraków Poland
| | - Anna Waszkielewicz
- Jagiellonian University Medical College Faculty of Pharmacy Chair of Organic Chemistry Department of Bioorganic Chemistry Medyczna 9 30-688 Kraków Poland
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13
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Shimmura M, Takase KI. Clinical utility of serum prolactin and lactate concentrations to differentiate epileptic seizures from non-epileptic attacks in the emergency room. Seizure 2022; 95:75-80. [PMID: 35016147 DOI: 10.1016/j.seizure.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To evaluate the diagnostic utility of serum prolactin (PRL) and lactate (LAC) concentrations for patients presenting with either or both convulsions and transient loss of consciousness (TLOC) in the emergency room (ER). METHODS This was a retrospective single-center study conducted in a tertiary care hospital ER. Medical records of consecutive patients who presented with convulsions or TLOC between January 2018 and December 2020 were reviewed. Patients with an ER diagnosis of epileptic seizures, psychogenic non-epileptic seizure (PNES), and syncope were selected for analysis. Serum PRL and LAC concentrations were measured within 3 h of the event and compared between groups. RESULTS Among the 440 eligible patients, 173 (39.3%) were included for analysis. Serum PRL concentration was significantly higher in patients with epileptic seizures with convulsions than in those with PNES with convulsions (p < 0.001) and convulsive syncope (p = 0.023). Serum LAC concentration was not significantly elevated in patients with convulsive syncope. Using a PRL cut-off value of 24.0 ng/mL, serum PRL concentration had 100.0% sensitivity and 82.9% specificity for differentiating between PNES and other attacks without convulsions. CONCLUSION Elevated serum PRL with normal serum LAC concentration in patients who have attacks with convulsions suggests convulsive syncope. Serum PRL concentration is useful in the diagnosis of PNES with convulsions. However, serum LAC concentration is not useful as a routine screening test for attacks without convulsions in the ER.
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Affiliation(s)
- Mitsunori Shimmura
- Department of Neurology, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan.
| | - Kei-Ichiro Takase
- Department of Neurology, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan
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14
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Maeda M, Okanishi T, Miyamoto Y, Hayashida T, Kawaguchi T, Kanai S, Saito Y, Maegaki Y. Predicting the Onset of Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion by Using Early Laboratory Data. Front Neurol 2021; 12:730535. [PMID: 34790160 PMCID: PMC8591104 DOI: 10.3389/fneur.2021.730535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) often causes various neurological sequelae, necessitating early and objective differentiation of AESD from a febrile seizure (FS). Therefore, we developed a scoring system that predicts AESD onset using only early laboratory data. Methods: We selected patients with AESD or FS admitted to the Tottori University Hospital between November 2005 and September 2020 and collected laboratory data from onset to discharge in patients with FS and from onset to the second neurological events in patients with AESD. Results: We identified 18 patients with AESD and 181 patients with FS. In comparison with patients with FS, patients with AESD showed statistically significant increases in ammonia (NH3), blood sugar (BS), and serum creatinine (Cr) levels, and the white blood cell (WBC) count, and a significant decrease in pH at <3 h from onset. We set the cut-off values and adjusted the weight of each of these parameters based on data obtained <3 h from onset and proposed a scoring system for predicting AESD. This system showed 91% sensitivity and 94% specificity for distinguishing AESD from FS. These accuracies were only slightly improved by the addition of information related to consciousness and seizure duration (sensitivity, 91%; specificity, 96%). Conclusion: NH3, BS, and Cr levels, WBC count, and pH were significantly different between patients with AESD and patients with FS at <3 h from seizure onset. This scoring system using these data may enable the prediction of AESD onset for patients under sedation or without precise clinical information.
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Affiliation(s)
- Masanori Maeda
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yosuke Miyamoto
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.,Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuya Hayashida
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.,Department of Pediatrics, Nagasaki University, Nagasaki, Japan
| | - Tatsuya Kawaguchi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Sotaro Kanai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yoshiaki Saito
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.,Division of Child Neurology, Saiseikai Yokohama City Tobu Hospital, Yokohama, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
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15
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Bauer PR, Tolner EA, Keezer MR, Ferrari MD, Sander JW. Headache in people with epilepsy. Nat Rev Neurol 2021; 17:529-544. [PMID: 34312533 DOI: 10.1038/s41582-021-00516-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Epidemiological estimates indicate that individuals with epilepsy are more likely to experience headaches, including migraine, than individuals without epilepsy. Headaches can be temporally unrelated to seizures, or can occur before, during or after an episode; seizures and migraine attacks are mostly not temporally linked. The pathophysiological links between headaches (including migraine) and epilepsy are complex and have not yet been fully elucidated. Correct diagnoses and appropriate treatment of headaches in individuals with epilepsy is essential, as headaches can contribute substantially to disease burden. Here, we review the insights that have been made into the associations between headache and epilepsy over the past 5 years, including information on the pathophysiological mechanisms and genetic variants that link the two disorders. We also discuss the current best practice for the management of headaches co-occurring with epilepsy and highlight future challenges for this area of research.
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Affiliation(s)
- Prisca R Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark R Keezer
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,School of Public Health, Université de Montréal, Montreal, Quebec, Canada.,Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.,NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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16
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Reply to: "Accuracy of CSF Lactate for Neurologic Outcome in Survivors of Cardiac Arrest". Neurocrit Care 2021; 35:276. [PMID: 34008103 DOI: 10.1007/s12028-021-01236-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
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17
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Magnusson C, Herlitz J, Höglind R, Wennberg P, Edelvik Tranberg A, Axelsson C, Zelano J. Prehospital lactate levels in blood as a seizure biomarker: A multi-center observational study. Epilepsia 2021; 62:408-415. [PMID: 33417237 PMCID: PMC7898511 DOI: 10.1111/epi.16806] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to assess the value of prehospital measurement of lactate level in blood for diagnosis of seizures in cases of transient loss of consciousness. METHODS Between March 2018 and September 2019, prehospital lactate was measured with a point-of-care device by the emergency medical services in an area serving a population of 900 000. A total of 383 cases of transient loss of consciousness were identified and categorized as tonic-clonic seizure (TCS), other seizure, syncope, or other cause, according to the final diagnosis in the electronic medical records system. Receiver operating characteristic curve analyses were used to identify the optimal lactate cut-off. RESULTS A total of 383 cases were included (135 TCS, 42 other seizure, 163 syncope, and 43 other causes). The median lactate level in TCS was 7.0 mmol/L, compared to a median of 2.0 mmol/L in all other cases (P < .001). The area under the curve (AUC) of TCS vs nonepileptic causes was 0.87 (95% confidence interval [CI] 0.83-0.91). The optimal cut-off (Youden index, 67.8%) was 4.75 mmol/L, with 79% sensitivity (95% CI 71-85) and 89% specificity (95% CI 85-93) for TCS. SIGNIFICANCE Prehospital lactate can be a valuable tool for identifying seizures in transient loss of consciousness. For acceptable specificity, a higher cut-off than that previously demonstrated for hospital-based measurements must be used when values obtained close to the time of the event are interpreted.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Prehospen-Centre for Prehospital Research, University of Borås, Borås, Sweden.,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Prehospen-Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Robert Höglind
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pär Wennberg
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Anna Edelvik Tranberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christer Axelsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Prehospen-Centre for Prehospital Research, University of Borås, Borås, Sweden.,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden
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18
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Côté JM, Bérubé AA, Bollée G. Association of Hyperuricemia With Acute Kidney Injury: Case Series Report Among Patients Hospitalized With General Tonic-Clonic Seizures. Can J Kidney Health Dis 2020; 7:2054358120977386. [PMID: 33343911 PMCID: PMC7727036 DOI: 10.1177/2054358120977386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/07/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Urate nephropathy is a rare cause of acute kidney injury. Although most risk factors are associated with chemotherapy, tumor lysis syndrome or rhabdomyolysis, occurrence following severe seizure has also been reported. Uric acid measurement following convulsion is rarely performed and, therefore, the incidence of hyperuricemia in this context is unknown. Objective: The objective is to present a case of urate nephropathy following generalized tonic-clonic seizure (GTCS) and to investigate the kinetics of serum uric acid and creatinine levels in a series of patients admitted for severe seizures. Design: Retrospective case report and prospective case series. Setting: Emergency room department and neurology unit of a tertiary care hospital. Patients: The study included 13 hospitalized patients for severe GTCS. Measurements: Type, timing, and duration of seizure episodes were documented. Demographic data, weight, hypouricemic therapy, and baseline serum creatinine were recorded. Blood samples (uric acid, creatinine, blood gas, lactate, and creatinine kinase) and urine samples (uric acid, creatinine, and dipstick) were prospectively collected at Day 0, 1, 2, and 3 following the GTCS episode. Methods: We identified and described one rare case of urate nephropathy following GTCS. Then, we presented the kinetic of uric acid and creatinine levels and the acute kidney injury incidence over the follow-up period. All analyses were using descriptive statistics. Results: During the study period, 13 patients with a median tonic-clonic seizure duration of 5.0 minutes (interquartile range [IQR], 2.0–12.5) were included. From day 0 to day 3, the median serum uric acid level decreased from 346.0 µmol/L (IQR, 155.0–377.5) to 178.0 µmol/L (IQR, 140.0–297.5) and median serum creatinine from 73.0 µmol/L (IQR, 51.0–80.0) to 57.0 µmol/L (IQR, 44.0–70.0). Acute kidney injury occurred in four patients. Limitations: This is a single-center observational study with small sample size, which does not allow us to demonstrate causality between the increase of uric acid levels observed and the occurrence of acute kidney injury. A delay between the first sampling and seizure episodes was observed and could explain the limited increase of uric acid levels captured. Conclusions: There is a signal for an acute increase of uric acid levels following a severe seizure before returning to baseline within 3 days. During that period, there might be an increased risk of acute kidney injury, although these changes seem to be usually mild and reversible. Our findings suggest that routine serum uric acid measurement in patients presenting with GTCS could help to identify those patients at risk of developing acute kidney injury as a result of acute hyperuricemia. Further larger studies are required to confirm the effectiveness of such screening in acute kidney injury prevention. Trial Registration: As an observational noninterventional study, no registration was required.
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Affiliation(s)
- Jean Maxime Côté
- Service of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, QC, Canada.,Clinical Research Centre, University College Dublin, Ireland
| | - Arline-Aude Bérubé
- Department of Neurology, Centre Hospitalier de l'Université de Montréal, QC, Canada
| | - Guillaume Bollée
- Service of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, QC, Canada
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19
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Nass RD, Akgün K, Elger C, Reichmann H, Wagner M, Surges R, Ziemssen T. Serum biomarkers of cerebral cellular stress after self-limiting tonic clonic seizures: An exploratory study. Seizure 2020; 85:1-5. [PMID: 33360039 DOI: 10.1016/j.seizure.2020.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/02/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE It has been debated for decades whether single, self-limited seizures damage cerebral cells. Meanwhile, very sensitive measurements of biomarkers have become available, i.e. tau, neurofilament protein light (NFL), glial fibrillary acidic protein (GFAP) and ubiquitin carboxyterminate hydrolase L1 (UCHL-1), which we explored in this study. METHODS Adult patients of the epilepsy monitoring unit were admitted to the study after written consent. Blood samples were drawn at baseline, immediately after a TCS and after two, six and 24 h. The markers were measured from frozen samples with a single-molecule array (SIMOA). RESULTS 20 patients and 20 seizures were included. All markers showed subtle but significant postictal increases and returned to normal within the next few hours (p < 0.05). An increase of at least 100 % from baseline was noted in 30 % of patients for tau, 25 % for UCHL-1 and 15 % for GFAP, while NFL levels never increased above 100 %. Lactate was slightly correlated with the tau increase (r = 0.47, p = 0.037), leukocytes were correlated with postictal changes of GFAP (r = 0.68 p = 0.001). CONCLUSION Our data supports the assumption that significant cerebral stress occurs in some but not all self-limited TCS. The postictal inflammatory response in particular seems to play an important role.
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Affiliation(s)
| | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Christian Elger
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Heinz Reichmann
- Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Marcus Wagner
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
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20
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Carmenate YI, Gutierrez EG, Kang JY, Krauss GL. Postictal stertor: Associations with focal and bilateral seizure types. Epilepsy Behav 2020; 110:107103. [PMID: 32460174 DOI: 10.1016/j.yebeh.2020.107103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of the present study was to determine the association between respiratory stertor and focal and bilateral seizure types. METHODS We characterized ictal and postictal behaviors during symmetric bilateral tonic-clonic (TC) and asymmetric TC seizures in the Johns Hopkins University (JHU) epilepsy monitoring unit, comparing these to focal unaware seizures. We measured the presence and duration of postictal stertorous respirations, postictal generalized electroencephalographic suppression (PGES), immobility/motor dysfunction, and encephalopathy and determined their associations and relationship to seizure types. RESULTS In initial seizures recorded in 80 consecutive patients, bilateral symmetric TC seizures (N = 35) were strongly associated with PGES (97%, p < 0.001) and postictal stertorous respirations (89%, p < 0.001). Only 10% of the 20 patients with asymmetric TC seizures had brief PGES; focal unaware seizures (N = 25) were not associated with PGES or stertorous breathing. Some patients (24%) with asymmetric or bilateral symmetric TC seizures had severe postictal encephalopathy with stertor that was separate or extended beyond periods of PGES. CONCLUSION Bilateral symmetric TC seizures, but not focal unaware seizures, have postictal stertor during PGES. Severe postictal encephalopathy, however, is also associated with motor dysfunction and stertor. Stertor appears to be a compensatory postictal respiratory pattern for ictal/postictal hypoxemia and occurs with PGES or postictal encephalopathy.
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Affiliation(s)
- Yaretson I Carmenate
- Department of Neurology, Johns Hopkins University, 600 N Wolfe Street, Meyer 2-147, Baltimore, MD, USA.
| | - Erie G Gutierrez
- Department of Neurology, Johns Hopkins University, 600 N Wolfe Street, Meyer 2-147, Baltimore, MD, USA.
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins University, 600 N Wolfe Street, Meyer 2-147, Baltimore, MD, USA.
| | - Gregory L Krauss
- Department of Neurology, Johns Hopkins University, 600 N Wolfe Street, Meyer 2-147, Baltimore, MD, USA.
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21
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cTnI, BNP and CRP profiling after seizures in patients with drug-resistant epilepsy. Seizure 2020; 80:100-108. [PMID: 32563168 DOI: 10.1016/j.seizure.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To profile serum levels of high sensitivity Troponin I (hs-cTnI), B-Type Natriuretic Peptide (BNP), and high sensitivity C Reactive Protein (hs-CRP), after epileptic seizures in patients with focal drug-resistant epilepsy, relating the results to the revised SUDEP-7 inventory. METHODS We prospectively evaluated patients admitted to our Epilepsy Monitoring Unit. hs-cTnI, BNP, and hs-CRP were measured at admission and after the first seizure. The revised SUDEP-7 Risk Inventory was calculated. The statistical significance level was set at 0.05. RESULTS Fifty-eight patients were included (53.4 % female). The index seizure was a focal to bilateral tonic-clonic seizure (FBTCS) in 25.9 % of the patients, and 17.5 % had post-ictal generalized EEG suppression (PGES). After the seizure, 25.9 % had a significant (above 50 %) increase in hs-cTnI, 23.3 % in BNP, and 4.3 % in hs-CRP. About 40 % had cardiovascular risk factors (CRF), without known cardiac disease. The elevation of one biomarker did not compel the elevation of another. hs-cTnI increase was associated with FBTCS, PGES, longer seizures, maximal ictal heart rate, and HR change. Increases in BNP were associated with CRF. hs-CRP increase was associated with PGES. We found no significant association between SUDEP-7 and any biomarker increase. SIGNIFICANCE Several patients had increases in biomarkers of myocardial necrosis/dysfunction after seizures, without significant association with the SUDEP-7 inventory. Different patterns of biomarkers' elevations point to multifactorial pathophysiologies hypothetically associated with incipient myocardial lesions. A larger cohort with follow-up data could help to clarify the clinical relevance of these findings.
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22
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Barbella G, Barras P, Rossetti AO, Novy J. Hypophosphatemia compared to classical biomarkers of tonic clonic seizures. Epilepsy Res 2020; 163:106326. [PMID: 32305859 DOI: 10.1016/j.eplepsyres.2020.106326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypophosphatemia was recently reported as a potential marker of tonic-clonic (TC) seizures among patients with transitory loss of consciousness (TLOC). Its value compared to classical markers (creatine kinase [CK] and lactate) is however unknown. AIM Compare the diagnostic performance of hypophosphatemia, plasma CK, and lactate levels for distinguishing TC seizures from other TLOCs, alone or in combination. METHODS 128 patients aged 18-90, consecutively admitted to our hospital emergency department for TLOC were included. Diagnostic accuracy of plasma phosphate, CK, and lactate levels were compared with ROC curves. RESULTS We found significantly higher CK (median 154 U/l, range 38-5608; vs 115.5, 37-2340 U/l; p = 0.037) and lower phosphatemia (median 0.79 mmol/l, 0.34-1.37; vs 0.93, 0.52-1.89 mmol/l, p = 0.007) in TC seizures compared to other TLOCs; lactatemia was not different, although using a smaller sample (n = 72). Hypophosphatemia was the only independent predictor of TC seizures, even in later samples (>2 h). Comparing ROC curves, Combining hypophosphatemia and hyperCKemia had higher diagnostic accuracy for TC seizures than hyper-CKemia alone (AUC 0.68, 95 % CI 0.571-0.783 vs. 0.59, 95 % CI 0.475-0.706; p = 0.018), but the combination was only marginally better than hypophosphatemia alone (AUC 0.67, 95 % CI 0.559-0.778). CONCLUSION Hypophosphatemia seems to be more useful than CK levels for diagnosing TC seizures in patients assessed in an emergency setting for TLOC. Combining both parameters together does not significantly increase the diagnostic yield. No conclusion could be drawn regarding the comparison with lactate. A prospective study is needed.
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Affiliation(s)
- Giuseppina Barbella
- Neurology Service, Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Switzerland; Neurology Unit, San Gerardo Hospital, Monza, Italy; School of Medicine and Surgery and Milan-Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Pierre Barras
- Master of Medicine, University of Lausanne, Switzerland
| | - Andrea O Rossetti
- Neurology Service, Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Switzerland
| | - Jan Novy
- Neurology Service, Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Switzerland.
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23
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Nass RD, Wagner M, Surges R, Holdenrieder S. Time courses of HMGB1 and other inflammatory markers after generalized convulsive seizures. Epilepsy Res 2020; 162:106301. [PMID: 32126476 DOI: 10.1016/j.eplepsyres.2020.106301] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/30/2020] [Accepted: 02/22/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Neuroinflammation and disruption of blood brain barrier (BBB) are important players in epileptogenesis, ictogenesis and pharmacoresistance. In this context, we investigated blood levels of HMGB1 and other inflammatory and BBB markers after generalized and focal to bilateral tonic-clonic seizures in serum, summarized under the term generalized convulsive seizures (GCS). METHODS We included consenting adults who were admitted to the epilepsy monitoring unit. Blood samples were drawn at baseline and immediately after a GCS as well as after 2, 6 and 24 h. We measured leukocytes, c-reactive protein (CRP), the danger-associated molecular patterns (DAMPs) high mobility group box 1 (HMGB1) and S100, receptor of advanced glycation end products (RAGE) alongside the BBB markers intercellular adhesion molecule-1 (ICAM1) and matrix metalloproteinase 9 (MMP9). Noradrenaline and lactate measurements were available from a previous study. P-levels <0.05 were regarded as significant. RESULTS Twenty-eight patients with 28 GCS were included. Leukocytosis occurred immediately after GCS and normalized within two hours (p < 0.001). S100 and HMGB1 both increased by ∼80 % (p < 0.001). MMP9 peaked after six hours with levels at 48.6 % above baseline. RAGE decreased by 17.6 % with a nadir at 24 h. CRP increased by 118 % with a peak at 24 h. ICAM1 remained stable (p = 0.068). Postictal HMGB1 correlated with postictal leukocytosis (r = 0.42; p = 0.025) and with MMP9 levels six hours later (r = 0.374; p = 0.05). Postictal lactate levels correlated with MMP9 at 6 h (r = 0.48; p = 0.01) and CRP at 24 h (r = 0.39; p = 0.04). Postictal noradrenaline correlated with lactate (r = 0.57; p = 0.02) and leukocytes (r = 0.39; p = 0.047). DISCUSSION The serum level of the DAMPs HMGB1 and S100 increase immediately after GCS. The hypothetical mechanism includes central nervous processes, such as glutamate toxicity and ROS release from seizing neurons but also muscular tissues. BBB breakdown is marked by the release of MMP9. Further research is needed to understand the complex interactions between electrical and metabolic stress, neuroinflammation and BBB mechanics in seizures and epilepsy. CONCLUSION Our study reveals signs of inflammation, neuronal damage and transitory disruption of BBB following single GCS, underscoring the widespread and possibily detrimental effects of recurrent seizures on brain properties. The long term impact on the disease course, however, is unclear.
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Affiliation(s)
- Robert D Nass
- Department of Epileptology, Bonn University Hospital, Bonn, Germany.
| | - Marcus Wagner
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, Bonn University Hospital, Bonn, Germany
| | - Stefan Holdenrieder
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany; Institute of Laboratory Medicine, German Heart Centre Munich, Munich, Germany
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