Doğan Ebru Apaydın, Ünal Ali, Ünal Aslıhan, Erdoğan Çağla
Akdeniz University School of Medicine, Neurology Department, Antalya, Turkey.
Akdeniz University School of Medicine, Neurology Department, Antalya, Turkey.
Epilepsy Behav. 2017 Oct;75:13-17. doi: 10.1016/j.yebeh.2017.07.003. Epub 2017 Aug 12.
The differential diagnosis of generalized tonic-clonic seizures (GTCS), psychogenic nonepileptic seizures (PNES), and syncope constitutes a major challenge. Misdiagnosis rates up to 20 to 30% are reported in the literature.
To assess the clinical utility of serum lactate levels for differentiation of GTCS, PNES, and syncope based on gender differences.
Data from 270 patients were evaluated retrospectively. Only patients ≥18 years old with the final diagnosis of GTCS, PNES, or syncope in their chart were recruited. Serum lactate levels were measured in the first 2h of the index event.
Serum lactate levels in patients with GTCS (n=157) were significantly higher than in the patients with PNES (n=25) (p<0.001) and syncope (n=88) (p<0.001). When compared with the females, serum lactate levels in patients with GTCS were significantly higher in the male subgroup (p=0.004). In male patients the ROC analysis yielded a serum lactate value of 2.43mmol/l with a sensitivity of 0.85 and a specificity of 0.88 as the optimal cut-off value to distinguish GTCS from other events. The ROC analysis for the AUC yielded a high estimate of 0.94 (95% confidence interval: 0.91-0.98). When a cut-off value of 2.43mmol/l was chosen for the females, which was an optimal value for male patients, the specificity was 0.85, however, the sensitivity was 0.64.
We propose that serum lactate level when measured in the first 2h after the index event has a high clinical utility in the differential diagnosis of GTCS, PNES, and syncope. With concomitant clinical signs and physical examination findings besides neuroimaging and EEG, elevated levels of lactate should be taken into account when evaluating a patient with impaired consciousness. On the other hand, the suggested cut-off value 2.43mmol/l might not have a discriminative effect between GTCS, PNES, and syncope in female patients. This finding should be verified in a prospectively designed study with a larger patient population.
全面强直 - 阵挛发作（GTCS）、精神性非癫痫发作（PNES）和晕厥的鉴别诊断是一项重大挑战。文献报道误诊率高达20%至30%。
基于性别差异评估血清乳酸水平在鉴别GTCS、PNES和晕厥中的临床效用。
对270例患者的数据进行回顾性评估。仅纳入年龄≥18岁且病历最终诊断为GTCS、PNES或晕厥的患者。在指数事件发生后的前2小时内测量血清乳酸水平。
GTCS患者（n = 157）的血清乳酸水平显著高于PNES患者（n = 25）（p < 0.001）和晕厥患者（n = 88）（p < 0.001）。与女性相比，GTCS患者的血清乳酸水平在男性亚组中显著更高（p = 0.004）。在男性患者中，ROC分析得出血清乳酸值为2.43mmol/l，敏感性为0.85，特异性为0.88，作为区分GTCS与其他事件的最佳截断值。AUC的ROC分析得出的估计值较高，为0.94（95%置信区间：0.91 - 0.98）。当为女性选择2.43mmol/l的截断值（这是男性患者的最佳值）时，特异性为0.85，然而，敏感性为0.64。
我们提出，在指数事件发生后的前2小时内测量的血清乳酸水平在GTCS、PNES和晕厥的鉴别诊断中具有较高的临床效用。除了神经影像学和脑电图外，结合临床体征和体格检查结果，在评估意识障碍患者时应考虑乳酸水平升高。另一方面，建议的截断值2.43mmol/l在女性患者中对GTCS、PNES和晕厥可能没有鉴别作用。这一发现应在前瞻性设计的、更大患者群体的研究中得到验证。
