Cerebrospinal fluid changes following epileptic seizures unrelated to inflammation

Abstract

Background and purpose Analyzing cerebrospinal fluid (CSF) is crucial in the diagnostic workup of epileptic seizures to rule out autoimmunity or infections as the underlying cause. Therefore, the description of post‐ictal changes in CSF is essential to differentiate between negligible and etiopathologically relevant changes in the CSF profile. Methods A retrospective analysis of 247 patients newly diagnosed with epileptic seizures and CSF analysis during diagnostic workup was conducted. Patients with possible or definitive autoimmune or infectious encephalitis were excluded. CSF results were evaluated for associations with seizure types, seizure etiology and electroencephalography (EEG) findings. Results An increased cell count (>4/μL) was found in 4% (n = 10), increased lactate concentration (>2.5 mmol/L) in 28% (n = 70), increased total protein (>500 mg/L) in 51% (n = 125) and a dysfunction of the blood–brain barrier in 29% (n = 71) of patients. Intrathecal immunoglobulin G production was observed in 5% (n = 12) of patients. Higher lactate concentrations were found in seizures with motor onset (P = 0.02) compared with those with non‐motor onset. Patients with generalized slow activity on EEG had significantly higher lactate values (P = 0.01) and albumin quotient (P = 0.05) than those with normal EEG. Conclusions Compared with mild pleocytosis and immunoglobulin synthesis, elevated lactate and total protein concentrations as well as blood–brain barrier dysfunction are frequently found following epileptic seizures. Our data suggest that seizure semiology might impact CSF profiles. The highest lactate concentrations were found following motor‐onset seizures. Our findings may help clinicians to avoid over‐interpretation of minor CSF changes; however, the exclusion of alternative causes should always be carefully considered, taking into account further clinical features.

Cerebrospinal fluid lactate in dogs with inflammatory central nervous system disorders

“…Finally, inclusion of a few incorrect diagnoses would be unlikely to substantially alter the main results or conclusions of the study. Secondly, we did not account for the potential effect of seizure activity on CSF lactate concentrations, which has been shown to alter this analyte in some human studies . The effect of seizures on CSF lactate in dogs requires further study.…”

Diagnostic value of cerebrospinal fluid analysis in epileptic cats with unremarkable brain MRI or hippocampal signal changes only

“…The CSF was contaminated with blood in 65 cases (74.7%). From these samples, 25 TNCC was increased in four cats (4.6%); of these, three had only a borderline increase in TNCC (7 cells/µl, 6 cells/µl and 6 cells/µl, respectively) and one had mildly increased TNCC (22 cells/µl). The four cats with mild pleocytosis were not tested for leucine-rich glioma-inactivated 1 (LGI1) antibodies.…”

“…23,24 In cats with postictal MRI changes, CSF analysis results are expected to be unremarkable or show only very mild postictal pleocytosis. 25 Cats with solely hippocampal MRI signal changes are an important proportion of feline epileptic patients, but this is also a problematic group. This originates from the 'cause-or-consequence' problem, as the seizure itself may cause a hippocampal pathology.…”

Human Herpesvirus 6 in the CSF of a Woman With New-Onset Seizures

“…The absence of IgG or IgM antibodies in the patient's CSF would, however, rather argue against this hypothesis. In fact, both MRI signal alterations on T2 and FLAIR sequences, 1,2 as well as CSF pleocytosis 14,15 without evidence of inflammation, may be seen after nonconvulsive status epilepticus, further complicating the interpretation of the positive PCR findings in the CSF.…”