Clinical utility of serum lactate levels for differential diagnosis of generalized tonic-clonic seizures from psychogenic nonepileptic seizures and syncope
| Autor: | Çağla Erdoğan, Ebru Apaydın Doğan, Aslihan Yuruktumen Unal, Ali Ünal |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Physical examination Electroencephalography Syncope Diagnosis Differential 03 medical and health sciences Behavioral Neuroscience Epilepsy Young Adult 0302 clinical medicine Neuroimaging Predictive Value of Tests Seizures Internal medicine medicine Psychogenic disease Humans Somatoform Disorders Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test biology business.industry Syncope (genus) 030208 emergency & critical care medicine Middle Aged medicine.disease biology.organism_classification Neurology Anesthesia Concomitant Lactates Epilepsy Generalized Female Neurology (clinical) Differential diagnosis business 030217 neurology & neurosurgery |
| Zdroj: | Epilepsybehavior : EB. 75 |
| ISSN: | 1525-5069 |
| Popis: | 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) (p0.001) and syncope (n=88) (p0.001). 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. |
| Databáze: | OpenAIRE |
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