Abstracts

Rationale: Prolonged or recurrent convulsive seizures, as well as self-sustained status epilepticus, is medical emergency with a complex pathophysiology associated with various physiological and biochemical changes and neuronal damage. Our pilot study demonstrated that the hypocretin (orexin) system might be impaired after generalized seizures (Rejdak et al., Epilepsia 2009). The present study aimed to assay hypocretin-1 in cerebrospinal fluid (CSF) of patients after generalized tonic clonic seizures (GTCS) and convulsive status epilepticus (SE).Methods: A study groups consisted of 59 consecutive patients admitted to a hospital neurological ward because of repetitive generalized tonic-clonic seizures (n=25), convulsive status epilepticus (n=34) and 29 controls. Diagnostic lumbar puncture was performed in control patients as well as in epileptic patients within 48 h after the GTCS seizures. Hypocretin-1 levels were measured in unextracted CSF samples, using a standardized commercial radioimmunoassay.Results: There was a significant overall difference in median CSF hypocretin-1 concentrations between controls and epileptic patients after convulsive generalized seizures ( p<0.001). The lowest concentrations were noted in a subgroup of patients with convulsive status epilepticus , compared to those with repetitive GTCS (p<0.05) or controls (p<0.001).Conclusions: The current result is suggestive of that hypocretin-1 system deficiency contributes to the complex pathophysiology of repetitive GTC seizures and status epilepticus. Hypocretin -1 might be an interesting marker of seizure related pathology in the central nervous system.