Bilinç kaybı yaşayan hastalarda epileptik nöbet ve senkop ayırıcı tanısında kullanılabilecek belirteçler

Abstract

Amaç: Bilinç kaybı, senkop ve epileptik nöbetlerin ortak belirtisidir. Çalışmamızda acil servise bilinç kaybı ile başvuran hastalarda senkop ve epileptik nöbet ayırıcı tanısı için kullanılabilecek klinik ve biyokimyasal biyobelirteçleri belirlemek amaçlanmıştır. Gereç ve Yöntemler: Hastanemiz acil servisine üç ay boyunca bilinç kaybı şikâyeti ile başvuran hastaların dosyaları ve laboratuvar incelemeleri (laktat, hemoglobin, nötrofil, lenfosit) sonuçları tarandı, demografik özellikleri ve eşlik eden hastalıkları kaydedildi. Elde edilen veriler istatistiksel analizinde SofaStat (Auckland, New Zealand) programı kullanıldı. Bulgular: Epileptik nöbet nedeniyle başvuran hastalar, senkop nedeniyle başvuranlara kıyasla daha genç hastalardı ancak cinsiyet dağılımı birbirine benzerdi. Senkop ile başvuranlarda diyabet ve hipertansiyon öyküsü daha fazlaydı. İlk kez başvuranlara kıyasla daha önce benzer nöbet yaşayanların epilepsi olma olasılığı daha fazlaydı. Epileptik nöbet ile başvuranlarda, epizot sonrasında konfüzyon öyküsü senkop ile başvuranlardan daha fazlaydı. Epileptik nöbet nedeniyle başvuranların serum laktat düzeyi ortancası (3,3 U/L), senkop nedeniyle başvuranlara (2,3 U/L) kıyasla anlamlı düzeyde daha yüksekti (p=0,002). Serum laktat değerleri analiz edildiğinde, epilepsi ve senkop hastalarını ayırt etmek için en iyi eşik değer 2,5 U/L idi. Bu eşik değerin tanısal doğruluk oranı % 60,5 iken, sensitivitesi %60,2 ve spesifisitesi %62,3 idi. Kadınların hemoglobin ve hematokrit değerlerinin ortancası erkeklere kıyasla anlamlı düzeyde daha düşüktü. Sonuç: Çalışmamızın sonuçları, serum laktat düzeylerinin epileptik nöbet nedeniyle başvuran hastaları senkop nedeniyle başvuranlardan ayırt etmede önemli bir biyobelirteç olduğunu göstermektedir. Serum laktat değeri özellikle hasta ve hasta yakınlarının epizodu tarifleyemediği durumlarda değerli bilgiler sunabilir.

Keywords

• Epileptik Nöbet
• Senkop
• Laktat
• Klinik ve Biyokimyasal Biyobelirteç

Markers that can be used in the differential diagnosis of epileptic seizure and syncope in patients with loss of consciousness

Abstract

Aim: Loss of consciousness is a common finding of syncope and epileptic seizures. In our study, we aimed to determine the clinical and biochemical biomarkers that can be used to differentiate syncope and epileptic seizures in patients admitted to emergency departments with loss of consciousness. Material and Methods: The files and laboratory examination results of the patients who applied to the emergency department for three months with loss of consciousness were scanned, and their demographic characteristics and accompanying disorders were derived. SofaStat (Auckland, New Zealand) program was used for statistical analysis of the obtained data. Results: Patients presenting with epileptic seizures are younger than those presenting with syncope but the gender distribution of patients was similar. Those presenting with syncope were more likely to have a history of diabetes and hypertension. The median serum lactate level (3.3 U/L) of those presenting with epileptic seizures was significantly higher than those presenting with syncope (2.3 U/L). (p=0.002) The best cut-off level of lactate level in differentiating the epileptic seizure and syncope was 2.5 U/L. The diagnostic accuracy of this level was 60.5%, whereas the sensitivity was 60.2% and specificity was 62.3%. The median hemoglobin and hematocrit values of women were significantly lower than men. Conclusion: The data in our study show that serum lactate levels are an important biomarker in differentiating patients presenting with epileptic seizures from those presenting with syncope. The serum lactate value can provide valuable information, in particular for the cases in whom the patient or their relatives could not describe the episode.

Keywords

• Epileptic seizure
• Syncope
• Lactate
• Clinical and Biochemical Biomarker

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