study of some clinical and biochemical markers of epileptic seizures

ABSTRACT

The adverse effects of anticonvulsant drugs, duration and expense of therapy and social implications make it essential for accurate discrimination of epileptic from non epileptic seizures [NES]. There is still no single biochemical marker for epileptic seizures and many patients being treated as epileptics are not actually so. Moreover, the coexistence of pseudoseizures with epilepsy is high. Recently few studies had investigated the neuroprotective erythropoietin [EPO] system in the central and peripheral nervous systems. However, the clinical importance of EPO as a specific biochemical marker for epileptic fits is not yet investigated. Sixty children divided into 3 groups were studied. Group I included 20 recently diagnosed epileptics, aged 3.5-15 years. Group II involved 20 children with recent NES, aged 2-14 years. Twenty children suffering fever of unknown origin with lumbar puncture as part of its diagnostic work up, aged 3-15 years represented group III [control group]. All children were suffering no other neurological, hematological or renal diseases. Thorough history, clinical examination and routine investigations, confirmed diagnosis and established exclusion criteria. CT brain, EEG and EMG were done for all patients. Peripheral white blood cells [WBCs], serum creatine kinase [CK] and serum and CSF albumin and erythropoietin [EPO] were measured 24 hours Post-ictally for all patients and on admission of control children. Family history was positive for epilepsy in 20% of epileptic children. Post-ictal symptoms followed more than a half of epileptic seizures and less than a quarter of NES. The most common types of epileptic seizures were generalized tonic-clonic [GTC], generalized tonic [GT], myoclonic then focal seizures. CT brain was normal among most epileptic and all non epileptic patients; with hemorrhage in two epileptics and calcification in only one. EEG showed focal [FEA], generalized [GEA] and multifocal epileptogenic activities [MFEA] among our recent epileptics. Peripheral WBCs, serum CK and CSF levels of EPO showed a significant elevation 24 hours Post-ictally following generalized tonic-clonic epileptic fits and to a lower extent following focal and non epileptic fits. The 3 parameters showed a significant positive correlation with seizure duration. Serum CK levels were markedly elevated [more than 200 U/L] and CSF levels of EPO increased by more than 2 standard deviations in a high percentage of epileptic seizures especially so; GTC seizures, with this marked degree of elevation as a more sensitive factor discriminating epileptic from non epileptic seizures. Post-ictal symptoms, peripheral WBCs, serum CK and CSF levels of EPO are important discriminative factors between epileptic and non epileptic seizures before proceeding to more sophisticated and expensive investigations