Emergency Department, Keelung Hospital, Department of Health, Executive Yuan, Keelung, Taiwan.
Epilepsia. 2011 Nov;52(11):2043-9. doi: 10.1111/j.1528-1167.2011.03279.x. Epub 2011 Oct 5.
To investigate the incidence and duration of transient hyperammonemia in seizures and to verify the significant confounders related to transient hyperammonemia in seizures.
One hundred twenty-one noncirrhotic adult patients with seizures admitted to the emergency department were enrolled in the study. Laboratory examination was performed, including plasma ammonia level assessment. In addition, the basic parameters, underlying systemic diseases, and seizure-related conditions were assessed. The patients were classified into a group with hyperammonemia on arrival and a group without, in order to compare seizure-related adverse events that occurred during a 9-month period.
The incidence of hyperammonemia in patients with seizures was 67.77%. Plasma ammonia levels in patients with generalized tonic-clonic (GTC) seizures were significantly higher than those in patients in the non-GTC seizure group (median 174.5 vs. 47 μg/dl; proportion 76.5% vs. 21.1%; p < 0.001). Median plasma ammonia levels decreased spontaneously from 250 to 54 μg/dl (p < 0.00001) in an average interval of 466.79 min. GTC seizures (p < 0.0001), male gender (p < 0.0001), bicarbonate (p < 0.0001), diabetes (p = 0.0139), and alcohol-related seizures (p = 0.0002) were significant factors associated with hyperammonemia on arrival. No significant differences related to admission rates or mortalities were found between the two groups.
The presence of transient hyperammonemia in patients with seizures is significantly related to GTC seizures, male gender, bicarbonate, diabetes, and alcohol-related seizures. The appropriate period to study ammonia levels following a seizure event is within 8 h. Because these phenomena are self-limited, ammonia-lowering management are not necessary. Hyperammonemia on arrival is not necessarily related to adverse outcomes.
研究癫痫发作时一过性高氨血症的发生率和持续时间，并验证与癫痫发作时一过性高氨血症相关的显著混杂因素。
本研究纳入了 121 例非肝硬化成年癫痫发作患者。进行了实验室检查，包括评估血浆氨水平。此外，评估了基本参数、基础系统性疾病和与癫痫发作相关的情况。将患者分为到达时伴有高氨血症组和不伴有高氨血症组，以比较 9 个月期间发生的与癫痫发作相关的不良事件。
癫痫发作患者高氨血症的发生率为 67.77%。全身强直阵挛性（GTC）癫痫发作患者的血浆氨水平明显高于非 GTC 癫痫发作组（中位数 174.5 比 47μg/dl；比例 76.5%比 21.1%；p<0.001）。平均间隔 466.79 分钟，中位血浆氨水平从 250 降至 54μg/dl（p<0.00001）。GTC 癫痫发作（p<0.0001）、男性（p<0.0001）、碳酸氢盐（p<0.0001）、糖尿病（p=0.0139）和酒精相关癫痫发作（p=0.0002）是到达时高氨血症相关的显著因素。两组之间的入院率或死亡率无显著差异。
癫痫发作患者存在一过性高氨血症与 GTC 癫痫发作、男性、碳酸氢盐、糖尿病和酒精相关癫痫发作显著相关。研究癫痫发作后氨水平的合适时间是 8 小时内。由于这些现象是自限性的，不需要降低氨水平的治疗。到达时的高氨血症不一定与不良结局相关。
