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
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Published:2023-10-12
Issue:1
Volume:5
Page:
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ISSN:2524-3489
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Container-title:Neurological Research and Practice
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language:en
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Short-container-title:Neurol. Res. Pract.
Author:
Abdelnaby RamyORCID, Elgenidy Anas, Heckelmann Jan, Bedewy Mahmoud Mostafa, Shabib Ahmed Samy, Ebrahim Mohamed Ayman, Elmenawi Khaled Abdelmoneim, Maallem Imene, Youssef Merna Wagih, Attia Abdelrahman M., Moawad Mostafa Hossam, Mohamed Khaled Ashraf, Gaballa Ahmed
Abstract
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.
Funder
RWTH Aachen University
Publisher
Springer Science and Business Media LLC
Subject
Neurology (clinical),Neurology
Reference34 articles.
1. da Silva, R. M. F. L. (2014). Syncope: epidemiology, etiology, and prognosis. Frontiers in Physiology, 5, 471. 2. Martin, R., Burneo, J. G., Prasad, A., Powell, T., Faught, E., Knowlton, R., et al. (2003). Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology, 61, 1791–1792. https://doi.org/10.1212/01.wnl.0000098890.13946.f5 3. Alsaadi, T. M., Thieman, C., Shatzel, A., & Farias, S. (2004). Video-EEG telemetry can be a crucial tool for neurologists experienced in epilepsy when diagnosing seizure disorders. Seizure, 13, 32–34. https://doi.org/10.1016/s1059-1311(03)00072-4 4. Dobesberger, J., Walser, G., Unterberger, I., Seppi, K., Kuchukhidze, G., Larch, J., et al. (2010). Video-EEG monitoring: safety and adverse events in 507 consecutive patients. Epilepsia, 52, 443–452. https://doi.org/10.1111/j.1528-1167.2010.02782.x 5. Brigo, F., Igwe, S. C., Erro, R., Bongiovanni, L. G., Marangi, A., Nardone, R., et al. (2014). Postictal serum creatine kinase for the differential diagnosis of epileptic seizures and psychogenic non-epileptic seizures: a systematic review. Journal of Neurology, 262, 251–257. https://doi.org/10.1007/s00415-014-7369-9
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