Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
AP-HP, Epilepsy Unit and Clinical Neurophysiology Department, DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France.
J Neurol. 2022 Jul;269(7):3752-3760. doi: 10.1007/s00415-022-11004-2. Epub 2022 Feb 21.
Status epilepticus (SE) is a life-threatening prolonged epileptic seizure. A rapid diagnosis is fundamental to initiate antiepileptic treatment and to prevent the development of neurological sequels. Several serum and cerebrospinal fluid biomarkers have been proposed to help in the diagnosis of SE. Nevertheless, previous studies were conducted on too small patient cohorts, precluding the utilization of interesting biomarkers for the SE diagnosis. Here, we aimed to assess the ability of Neuron Specific Enolase (NSE), S100-beta protein (S100B) and progranulin to help in the diagnosis of SE in a large cohort of patients (36 control patients, 56 patients with pharmacoresistant epilepsy and 82 SE patients). Blood NSE, S100B and progranulin levels were higher in SE patients when compared with control patients or patients with pharmacoresistant epilepsy. Both NSE and progranulin levels were higher in cerebrospinal fluid from SE patients when compared with control patients. The receiver-operating characteristics curves revealed good accuracy at detecting SE for serum S100B (AUC 0.748) and plasma progranulin (AUC 0.756). The performances were lower for serum NSE (AUC 0.624). Eighty-four percent of patients with serum S100B levels above 0.09 ng/mL presented with a SE, whereas 90% of patients without SE had serum S100B levels lower than 0.09 ng/mL. Serum S100B levels were not significantly different according to SE etiology, SE semiology or SE refractoriness. Our results confirm that NSE, S100B and progranulin levels are increased after SE. We suggest that serum S100B levels might be added to clinical evaluation and electroencephalogram to identify difficult-to-diagnose form of SE.
癫痫持续状态（SE）是一种危及生命的延长性癫痫发作。快速诊断对于启动抗癫痫治疗和预防神经后遗症的发展至关重要。已经提出了几种血清和脑脊液生物标志物来帮助 SE 的诊断。然而，之前的研究都是在太小的患者队列中进行的，排除了利用有趣的 SE 诊断生物标志物的可能性。在这里，我们旨在评估神经元特异性烯醇化酶（NSE）、S100-β 蛋白（S100B）和颗粒蛋白前体在帮助诊断大样本患者队列中的 SE 方面的能力（36 名对照患者，56 名耐药性癫痫患者和 82 名 SE 患者）。与对照患者或耐药性癫痫患者相比，SE 患者的血液 NSE、S100B 和颗粒蛋白前体水平更高。与对照患者相比，SE 患者的脑脊液中 NSE 和颗粒蛋白前体水平更高。受试者工作特征曲线显示，血清 S100B（AUC 0.748）和血浆颗粒蛋白前体（AUC 0.756）检测 SE 的准确性较好。血清 NSE 的性能较低（AUC 0.624）。血清 S100B 水平高于 0.09ng/ml 的 84%患者出现 SE，而没有 SE 的 90%患者的血清 S100B 水平低于 0.09ng/ml。SE 病因、SE 症状学或 SE 难治性后血清 S100B 水平无显著差异。我们的结果证实，SE 后 NSE、S100B 和颗粒蛋白前体水平升高。我们建议将血清 S100B 水平添加到临床评估和脑电图中，以识别难以诊断的 SE 形式。
