Serum Ammonia as a Biomarker to Differentiate Between True Epileptic and Psychogenic Non-epileptic Seizures: A Cross-sectional Study.

BACKGROUND

A kind of conversion condition known as psychogenic non-epileptic seizures (PNES) is characterised by brief episodes that resemble epileptic fits but lack electroencephalographic (EEG) confirmation. Although the clinical history plays a significant role in the seizure diagnosis, imaging and serum markers are included in the initial evaluation for patients who present to the emergency.

OBJECTIVES

To validate the prevalence of serum ammonia as a biomarker in differentiating true epileptic and non-epileptic seizures.

MATERIAL METHODS

The study was a hospital-based observational, prospective comparative study spanning over 2 years after surpassing the patient consent, inclusion and exclusion criteria.

RESULTS

The mean of the study participants were middle-aged, males predominant in IES and females in PNES. A slightly higher proportion of the patients in the IES group had episodes of less than 5 minutes in the PNES group, where episodes lasted between 5 to 10 minutes. Awareness of symptoms was observed more frequently in the PNES group. The area under the curve (AUC) for the serum ammonia level at arrival was 0.972 (95% CI: 0.94-0.99) with a value of < .001.

CONCLUSION

Mean serum ammonia levels at arrival and after 48 hours of admissions in the idiopathic epileptic seizure group were significantly higher compared to the PNES group with value < .001, validating its use as a biomarker.