Authors :
Presenting Author: Estevo Santamarina, MD, PhD – Vall Hebron Hospital
Laura Abraira, MD, PhD – Vall Hebron Hospital; Daniel Campos, MD – Vall Hebron Hospital; Elena Fonseca, MD, PhD – Vall Hebron Hospital; Sofia Lallana, MD – Vall Hebron Hospital; Samuel Lopez-Maza, MD – Vall Hebron Hospital; Anna Penalba, Biochemistry – Vall Hebron Hospital; Manuel Quintana, PhD – Vall Hebron Hospital; Manuel Toledo, MD, PhD – Vall Hebron Hospital
Rationale:
Status epilepticus (SE) is a life-threatening prolonged epileptic seizure. A rapid diagnosis is fundamental in SE to initiate antiepileptic treatment and to prevent neurological sequels. Several serum biomarkers have been proposed to help in the diagnosis of SE, none of them disease-specific. We aimed to assess the ability of new biomarkers in serum to help in the diagnosis of SE.
Methods:
We selected serum samples from a prospective database of patients with suspected epileptic seizures who arrived at the emergency department (ED). From this database, we chose samples from 80 patients diagnosed with status epilepticus (SE) and 80 patients who did not meet the criteria for SE. The selection was based on matching the patients by age, sex, and the presence of brain injury. We measured the levels of APOC4, BAND3 (SLC4A1), CADH-1, IGHG2, and SRC. Additionally, we included S100B, enolase, and HMGB1 to replicate the results obtained in previous studies
Results:
There were no differences between cases and controls regarding age (p=0.171), sex (p=1) or previous functional status measured by mRS (p=0.093). Among SE patients, aetiology was acute symptomatic in 33 (41.3%), delayed symptomatic in 24 (30.0%), progressive symptomatic in 17 (21.3%) and 6 (7.5%) were considered cryptogenic. Controls had a final diagnosis of seizure cluster in 15(18.8%), isolated seizure in 42 (52.5%) and no seizure in 23 (28.8%). Regarding serum biomarkers, SE patients showed some differences, with higher levels of APOC4 (12031pg/ml vs 9506pg/ml;p=0.006), BAND3 (3105pg/ml vs. 2505pg/ml;p=0.014), CADH-1 (249ng/ml vs. 229ng/ml;p=0.039) and S100B (0.082μg/L vs. 0.049μg/L;p=0.003). No differences were found in the remaining biomarkers. After a logistic regression using the best cut-off points, only APOC4 (p=0.007), BAND3 (p=0.030) and S100B (p< 0.001) levels were significantly higher in SE patients. In ED patients with suspected epileptic seizure, a combination of high values for these three biomarkers increases the probability of Status to 85.2%.