ArticleEpilepsia open2019
Acute metabolic effects of tonic-clonic seizures.
Article in Epilepsia open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed, 46 citations in OpenAlex.
- Prehospital lactate, transfer time, and early mortality across emergency diagnostic categories.Critical care (London, England) · 2026Observational
- Alterations of acid-base- and electrolyte status immediately following electroconvulsive therapy.Journal of neural transmission (Vienna, Austria : 1996) · 2026Observational
- Enhanced Glycolysis-Driven Histone H3K18 Lactylation Regulates Epileptogenesis by Modulating the E3 Ubiquitin Ligase COP1.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Hypophosphatemia in the first seizure clinic: Data from a second UK center.Epilepsia open · 2026Article
- Extreme acidosis in hospitalised patients: A 10-year single-centre, retrospective analysis.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Hypophosphatemia in suspected seizures evaluated in first seizure clinics and neurology consults.Epilepsia open · 2025Article
- The acid-base balance homeostasis reflected by urine pH in children with infantile epileptic spasm syndrome may be associated with response to adrenocorticotropic hormone treatment: a retrospective cohort study.Translational pediatrics · 2025Article
- COScientific reports · 2025Article
- Causal link between oxidative stress and epilepsy: A two-sample Mendelian randomization study.Brain and behavior · 2024Article
- Article
- Biomechanical Effects of Seizures on Cerebral Dynamics and Brain Stress.Brain sciences · 2024Article
- High lactic acid levels in the brain contribute to the generation of focal slowing on the electroencephalogram.Frontiers in neurology · 2024Review
- The role of creatine kinase in distinguishing generalized tonic-clonic seizures from psychogenic non-epileptic seizures (PNES) and syncope: a retrospective study and meta-analysis of 1300 patients.Neurological research and practice · 2023Review
- Use of haemodiafiltration in the treatment of massive caffeine intoxication in a dog.Veterinary medicine and science · 2023Article
- Headache in people with epilepsy.Nature reviews. Neurology · 2021Review
- Reply to: "Accuracy of CSF Lactate for Neurologic Outcome in Survivors of Cardiac Arrest".Neurocritical care · 2021Article
- Prehospital lactate levels in blood as a seizure biomarker: A multi-center observational study.Epilepsia · 2021Observational
- Predicting the Onset of Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion by Using Early Laboratory Data.Frontiers in neurology · 2021Article
- Association of Hyperuricemia With Acute Kidney Injury: Case Series Report Among Patients Hospitalized With General Tonic-Clonic Seizures.Canadian journal of kidney health and disease · 2020Article
- Acute metabolic effects of tonic-clonic seizures.Epilepsia open · 2019Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTonic-clonic seizures (TCS) lead to metabolic stress and changes in related blood markers. Such markers may indicate harmful conditions but can also help to identify TCS as a cause of transient loss of consciousness. In this study, we hypothesized that the alterations of circulating markers of metabolic stress depend on the clinical features of TCS.
methodsNinety-one adults undergoing video-EEG monitoring participated in this prospective study. Electrolytes, renal parameters, creatine kinase (CK), prolactin (PRL), lactate, ammonia, glucose, and other parameters were measured at inclusion and different time points after TCS.
resultsA total of 39 TCS were recorded in 32 patients (six generalized onset tonic-clonic seizures in 6 and 33 focal to bilateral tonic-clonic seizures in 26 patients). Shortly after TCS, mean lactate, ammonia, and PRL levels were significantly increased 8.7-fold, 2.6-fold, and 5.1-fold, respectively, with levels of more than twofold above the upper limits of the normal (ULN) in 90%, 71%, and 70% of the TCS and returned to baseline levels within 2 hours. Only postictal lactate levels were significantly correlated with the total duration of the tonic-clonic phase. In contrast, CK elevations above the ULN were found in three TCS (~10%) only with a peak after 48 hours. Immediately after the TCS, hyperphosphatemia occurred in one third of the patients, whereas hypophosphatemia was observed in one third 2 hours later. TCS led to subtle but significant alterations of other electrolytes, creatinine, and uric acid, whereas glucose levels were moderately increased. SIGNIFICANCE: Lactate is a robust metabolic marker of TCS with elevations found in ~90% of cases within 30 minutes after seizure termination, whereas ammonia rises in ~ 70%, similarly to PRL. Phosphate levels show an early increase and a decrease 2 hours after TCS in a third of patients. CK elevations are rare after video-EEG-documented TCS, challenging its value as a diagnostic marker.
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