Neufeld M Y, Treves T A, Chistik V, Korczyn A D
Department of Neurology, Tel-Aviv Sourasky Medical Center, Israel.
Acta Neurol Scand. 1997 Mar;95(3):137-9. doi: 10.1111/j.1600-0404.1997.tb00084.x.
In a prospective study we evaluated patients with first generalized tonic-clonic seizure (GTCS) (n = 16, age: 31 +/- 11 years, 8 women) and patients with vaso-vagal syncope (VVS) (n = 17, age: 32 +/- 13 years, 8 women), diagnosed on the basis of past history and clinical presentation who had serum creatine kinase (CK) levels assessed at admission to the emergency room and 24-26 h later. Patients with physical injuries were excluded.
On admission, CK levels were > 130 mU/ml (2.16 microkat/l) in 25% (4/16) GTCS vs 6% (1/17) VVS patients; 24 h later, the figures were 56% (9/16) vs 12% (2/17) respectively. For GTCSD patients CK level > 200 mU/ml (3.33 microkat/l) had a sensitivity and specificity of 0.12 and 0.94 on the first day, and 0.25 and 1.0 respectively on the second day. The change in the CK level from the first to the second day was 155 +/- 266 mU/ml (2.58 +/- 4.43 microkat/l) for GTCS group and -2 +/- 37 mU/ml (-0.03 +/- 0.61 microkat/l) in VVS. An increase of more than 15 mU/ml (0.25 microkat/l) was observed in 11/16 GTCS patients and only in 1/17 VVS patients. Taking an increase of > 15 mU/ml (0.25 microkat/l) as a cut-off value, the sensitivity of this figure is 0.69 and specificity 0.94. An increase of > 15 mU/ml (0.25 microkat/l) in CK level among the patients with normal CK on both days was seen in 50% of GTCS but in none with VVS. Using the criteria of CK levels > 200 mU/ml (3.33 microkat/l) (on either day) and/or elevation from the first to the second day of > 15 mU/ml (0.25 microkat/l), there were only 12% false negatives and 12% false positives.
We conclude that a higher increase in CK levels from the first to the second day occurs in GTCS as compared to VVS, and even when both sequential tests are within the normal range, an increase of at least 15 mU/ml (0.25 microkat/l) is highly indicative of an epileptic event. CK levels above 200 mU/ml (3.33 microkat/l) are unlikely to be the result of VVS.
在一项前瞻性研究中，我们评估了首次发生全面性强直阵挛发作（GTCS）的患者（n = 16，年龄：31±11岁，8名女性）和血管迷走性晕厥（VVS）患者（n = 17，年龄：32±13岁，8名女性），这些患者根据既往病史和临床表现进行诊断，在急诊室入院时及24 - 26小时后评估血清肌酸激酶（CK）水平。排除有身体损伤的患者。
入院时，25%（4/16）的GTCS患者CK水平> 130 mU/ml（2.16微kat/L），而VVS患者为6%（1/17）；24小时后，相应数字分别为56%（9/16）和12%（2/17）。对于GTCS患者，CK水平> 200 mU/ml（3.33微kat/L）在第一天的敏感性和特异性分别为0.12和0.94，第二天分别为0.25和1.0。GTCS组从第一天到第二天CK水平的变化为155±266 mU/ml（2.58±4.43微kat/L），VVS组为 - 2±37 mU/ml（ - 0.03±0.61微kat/L）。11/16的GTCS患者观察到增加超过15 mU/ml（0.25微kat/L），而VVS患者中只有1/17。以增加> 15 mU/ml（0.25微kat/L）为临界值，该数值的敏感性为0.69，特异性为0.94。两天CK均正常的患者中，50%的GTCS患者CK水平增加> 15 mU/ml（0.25微kat/L），而VVS患者无一如此。使用CK水平> 200 mU/ml（3.33微kat/L）（任一天）和/或从第一天到第二天升高> 15 mU/ml（0.25微kat/L）的标准，假阴性率仅为12%，假阳性率为12%。
我们得出结论，与VVS相比，GTCS患者从第一天到第二天CK水平升高更高，并且即使两次连续检测均在正常范围内，至少增加15 mU/ml（0.25微kat/L）高度提示癫痫发作。CK水平高于200 mU/ml（3.33微kat/L）不太可能是VVS的结果。
