Is the differential diagnosis of epilepsy and psychogenic nonepileptic seizures possible by assessing the neutrophil/lymphocyte ratio?

Morkavuk, Gulın; Koç, Güray; Leventoğlu, Alev

doi:10.1016/j.yebeh.2020.107736

Cited by 12 publications

(16 citation statements)

References 25 publications

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“…Morkavuk et al [ 4 ] conducted a study on 50 patients, 14 with psychogenic nonepileptic seizures (PNES) and 36 with epilepsy. Twenty-one epilepsy patients experienced generalized seizures, whereas 15 had seizures with a focal onset.…”

Section: Resultsmentioning

confidence: 99%

“…Neutrophils are the most abundant leukocytes involved in innate immunity, and the level of neutrophil cells increases in systemic inflammation. A study published in 2021 observed that the number of neutrophils was considerably higher in the postseizure phase than the preseizure phase in the group with generalized epilepsy [ 4 ]. Özdemir et al found an association between the status epilepticus and neutrophil-mediated inflammation [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The results of a study published in 2021 suggest that TNF α and neutrophils regulate neuronal hyperexcitability, which is associated with a variety of etiologies [ 33 ]. This is important since Morkavuk et al claimed that increased excitability of neuronal cells might cause epilepsy disease [ 4 ]. So, another connection between elevated neutrophil numbers and epilepsy disease can be seen.…”

Section: Discussionmentioning

confidence: 99%

“…This brain disorder is marked by seizures and cognitive problems [3]. Epilepsy affects nearly 1% of the population around the world, which is about 70 million individuals, and 80% of those affected live in the middle-and low-income nations [4]. Inflammation has been shown to play a role in the initiation and development of epilepsy in animal models [5], and penetration of inflammatory cells in epileptic tissues has been discovered [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Neutrophil to Lymphocyte Ratio in Epilepsy: A Systematic Review

Hosseini

Mofrad

Mokarian

et al. 2022

Mediators of Inflammation

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This study was conducted to summarize the results of studies investigating the role of neutrophil to lymphocyte ratio (NLR) in epilepsy. The search was conducted on PubMed, Scopus, and Web of Science up to December 25, 2021. Finally, a total of seven studies were included in the review. The NLR in patients who were in the acute phase was higher than that of healthy. NLR in the patients who were in either acute or subacute phase was higher than in healthy controls. A significant difference in NLR levels between the acute and subacute phases was also noted. Epilepsy is one of the most important neurological diseases in the world, and millions of people around the world suffer from it, and a cheap and fast biomarker is needed for it. The interesting thing is that inflammation plays a role in epilepsy, and elevated NLR value can be a good biomarker of inflammation and, as a result, for epilepsy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neutrophil to Lymphocyte Ratio in Epilepsy: A Systematic Review

Hosseini

Mofrad

Mokarian

et al. 2022

Mediators of Inflammation

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“…The function of peripheral immune cell subsets is altered during epileptic seizures, such as upregulation of CD32-expressed granulocytes and monocytes reduction of HLA-DR-expressed monocytes after seizures ( 30 ), and this monocyte infiltration may lead to the recurrence of epileptic seizures ( 31 ). On the other hand, a significant increase in the number of blood leukocytes after seizures has been reported in patients with generalized or focal onset seizures, with peripheral blood leukocyte counts above the upper limit of normal in approximately one-third of patients after generalized onset seizures ( 16 , 32 ). In this retrospective cohort study, we demonstrated that, compared to healthy controls, PWE had higher levels of leukocyte and NLR at admission within 24 h of acute seizure and during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

The correlation of temporal changes of neutrophil-lymphocyte ratio with seizure severity and the following seizure tendency in patients with epilepsy

Yang²,

Hu³

et al. 2022

Front. Neurol.

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BackgroundChanges in the neutrophil-lymphocyte ratio (NLR) has been reported to be associated with epilepsy. Here we aim to investigate the correlation of temporal changes of NLR level with seizure severity and the follow-up seizure attacks in patients with epilepsy (PWE).MethodsWe performed a retrospective analysis of the laboratory data including leukocyte count and NLR within 24 h of acute seizure and during the follow-up period of 5–14 days after acute seizure (NLR1, NLR2, respectively) in 115 PWE, and 98 healthy individuals were included as controls in this study. The correlation of laboratory data with seizure types, etiology of epilepsy, anti-seizure drugs (ASDs), seizure severity, and the follow-up seizure attacks in PWE was studied.ResultsLeukocyte count (P < 0.001) and NLR level (P < 0.001) were found significantly different between PWE and controls. On the other hand, a multivariable logistic regression analysis showed that NLR1 level (OR = 2.992, P = 0.001) and admission leukocyte (OR = 2.307, P = 0.002) were both independently associated with acute epileptic seizures. Especially, higher NLR1 level was significantly associated with status epileptics (P = 0.013) and recurrent seizures after admission (P < 0.001). Furthermore, the multivariable logistic regression analysis indicated that higher NLR1 was a predictor for the tendency of the following recurrent seizure attacks (OR = 1.144, P = 0.002). NLR2 was inversely correlated with ASDs taken (P = 0.011). Levels of NLR1 (r = 0.441, P < 0.001) and NLR2 (r = 0.241, P = 0.009) were both positively correlated with seizure severity.ConclusionsSeizures were correlated with the alterations of systemic inflammation reflected by leukocyte and NLR. NLR1 and admission leukocyte were both independently associated with acute epileptic seizures. Higher NLR1 was associated with status epilepticus and independently predicted the tendency of the following epileptic seizures. NLR2 was significantly associated with ASDs taken. Besides, NLR may be used as a biomarker for seizure severity.

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Development and validation of a peripheral cell ratio and lactate score for differentiating status epilepticus from prolonged psychogenic nonepileptic seizures

Tan,

Sanfilippo,

Colman

et al. 2023

Epilepsia Open

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ObjectiveDifferentiating status epilepticus (SE) from prolonged psychogenic nonepileptic seizures (pPNES) can be difficult clinically. We aimed to define the utility of peripheral cell counts, cell ratios, and lactate levels in distinguishing SE from pPNES.MethodsRetrospective two‐center study investigating the sensitivity and specificity of acute (≤12 h of event offset) peripheral cell counts, cell ratios (neutrophil–lymphocyte ratio, neutrophil–monocyte ratio, monocyte–lymphocyte ratio, platelet–lymphocyte ratio, systemic immune‐inflammatory index [SII], systemic inflammatory response index [SIRI]), and lactate levels in differentiating SE from pPNES. Patients were identified from two tertiary hospitals, with one forming the development cohort and the other the validation cohort. Using generalized additive models to generate biomarker vs time curves, optimal blood collection times were defined for set parameters. Three diagnostic scores combining neutrophil count, SII, or SIRI with lactate levels were developed and validated in separate cohorts.ResultsFor the development cohort, 1262 seizure‐like events were reviewed and 79 SE and 44 pPNES events were included. For the validation cohort, 241 events were reviewed and 20 SE and 11 pPNES events were included. Individually, the biomarkers generally had low sensitivity and reasonable specificity for differentiating SE from pPNES, with the neutrophil count, SIRI, and SII performing best with sensitivities of 0.65–0.84, specificities of 0.64–0.89, and ROC AUCs of 0.78–0.79. Lactate levels peaked at 60 min, while cell counts and ratios peaked after 240 min. Combining early peaking lactate levels and later peaking neutrophil count, SIRI or SII resulted in three scores that improved predictive potential with sensitivities of between 0.75 and 0.79, specificities between 0.93 and 1.00, and ROC AUCs of 0.89–0.91.SignificanceLactate levels peak early post‐SE, whereas cell counts and ratios do so later. The differing post‐event time profiles of lactate levels vs neutrophil count, SIRI, and SII allow incorporation into three separate scores which can assist in differentiating SE from pPNES.

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Is the differential diagnosis of epilepsy and psychogenic nonepileptic seizures possible by assessing the neutrophil/lymphocyte ratio?

Cited by 12 publications

References 25 publications

Neutrophil to Lymphocyte Ratio in Epilepsy: A Systematic Review

Neutrophil to Lymphocyte Ratio in Epilepsy: A Systematic Review

The correlation of temporal changes of neutrophil-lymphocyte ratio with seizure severity and the following seizure tendency in patients with epilepsy

Development and validation of a peripheral cell ratio and lactate score for differentiating status epilepticus from prolonged psychogenic nonepileptic seizures

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