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Acute Symptomatic Seizures: Clinical and Experimental Studies
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Uppsala University. (epilepsy)
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Epilepsy is defined as a condition with recurrent unprovoked seizures. When seizures are believed to be provoked they fall into another category of situation-related seizures, i.e. acute symptomatic seizures (ASS). The definition of ASS is a clinical seizure occurring in close temporal relationship with an acute insult in the central nervous system (CNS), which may be metabolic, toxic, structural, infectious or inflammatory. The prognosis after unprovoked seizures and ASS differs with regard to risk of seizure recurrence and mortality.

This thesis focuses on seizures occurring in relation to common dysmetabolic conditions and subarachnoid haemorrhage (SAH). Specifically, the occurrence of ASS in patients with different levels of hyponatraemia and hypoglycaemia was studied. Furthermore an experimental study in rodents was conducted to explore the relationship between chemically induced status epilepticus (SE) and hyponatraemia. In addition, seizures in relation to acute SAH were recorded and related to appearance of development of delayed cerebral ischemia (DCI). Finally, measurement of neurofilament light (NFL) and tau in the cerebrospinal fluid (CSF) was performed.

In a large number of patients with hyponatremia a gradual increase (2.5 % – 11 %) in risk of seizures with declining sodium levels was noted. Seizures were the only neurologic manifestation of hyponatraemia in patients with moderately decreased sodium levels (> 115 mM).

In a study of patients with hypoglycaemia, a notably low risk for seizures was found. Absolute risk for neurological symptoms at glucose < 2.0 mM (95% CI) was 0.25 (0.13-0.41). This is a finding of potentially great clinical relevance, since seizures in the presence of hypoglycaemia are often presumed to be acutely symptomatic.

In the animal study of acute hyponatraemia on kainic acid (KA) induced status epilepticus (SE) the hyponatraemic animals displayed an increased frequency of epileptiform activity and had longer duration of seizures. These results support the clinical observations that hyponatraemia aggravates SE.

In the study of patients with SAH seizures were frequent (36% of all patients) but did not predict the development of DCI. Measurement of the CSF biomarker tau at different time points revealed increased tau concentration between days 4 and 10, and may be associated with DCI. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , p. 52
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1298
Keywords [en]
Seizure.
National Category
Medical and Health Sciences
Research subject
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-314770ISBN: 978-91-554-9812-2 (print)OAI: oai:DiVA.org:uu-314770DiVA, id: diva2:1071723
Public defence
2017-03-24, Gunnesalen i Psykiatrins hus, Akademiska sjukhusets kärnområde, Psykiatrins hus, Ingång 10, 751 85, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2017-03-03 Created: 2017-02-06 Last updated: 2017-03-06
List of papers
1. Hyponatremia and risk of seizures: A retrospective cross-sectional study
Open this publication in new window or tab >>Hyponatremia and risk of seizures: A retrospective cross-sectional study
2011 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 52, no 2, p. 410-413Article in journal (Refereed) Published
Abstract [en]

This retrospective cross-sectional study was carried out to study the association between different levels of hyponatremia and the occurrence of epileptic seizures in patients without a prior epilepsy diagnosis. We identified from the hospital database, 363 inpatients of a Swedish County hospital who between March 2003 and August 2006 were found to have serum sodium levels < 125 mm. Medical records were reviewed and we identified 11 patients with seizures in conjunction with their hyponatremia. Seizures were the only neurologic manifestation of hyponatremia in patients with serum sodium levels > 115 mm. Of 150 patients reviewed with serum sodium levels of 120-124 mm, one had a seizure. Using 120-124 mm as reference, odds ratios (95% confidence interval) for having seizures at serum sodium levels of 115-119 mm was 3.85 (0.40-37.53), 8.43 (0.859-82.85) at 110-114 mm, and 18.06 (1.96-166.86) at < 110 mm.

Keywords
Seizures, Hyponatremia, Serum sodium, Metabolic derangement
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-149037 (URN)10.1111/j.1528-1167.2010.02939.x (DOI)000287239800026 ()21314679 (PubMedID)
Available from: 2011-03-15 Created: 2011-03-15 Last updated: 2017-12-11
2. Hypoglycaemia and Risk of Seizures: a Retrospective Cross-Sectional Study
Open this publication in new window or tab >>Hypoglycaemia and Risk of Seizures: a Retrospective Cross-Sectional Study
2014 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 55, p. 231-231Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-229373 (URN)000337979300697 ()
Conference
11th European Congress on Epileptology, JUN 29-JUL 03, 2014, Stockholm, SWEDEN
Available from: 2014-08-06 Created: 2014-08-06 Last updated: 2017-12-05Bibliographically approved
3. Hyponatremia augments kainic-acid induced status epilepticus in the mouse: A model for dysmetabolic status epilepticus
Open this publication in new window or tab >>Hyponatremia augments kainic-acid induced status epilepticus in the mouse: A model for dysmetabolic status epilepticus
2013 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 54, no SI, p. 106-106Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-209225 (URN)000323826600032 ()
Conference
4th London-Innsbruck-Colloquium on Status Epilepticus, APR 04-06, 2013, Salzburg, AUSTRIA
Available from: 2013-10-15 Created: 2013-10-15 Last updated: 2017-12-06Bibliographically approved
4. Epileptic seizures and CSF concentrations of neurofilament light and tau proteins in patients with subarachnoid hemorrhage.
Open this publication in new window or tab >>Epileptic seizures and CSF concentrations of neurofilament light and tau proteins in patients with subarachnoid hemorrhage.
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-314519 (URN)
Available from: 2017-02-03 Created: 2017-02-02 Last updated: 2017-02-06

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