Analysis of cerebrospinal fluid glial fibrillary acidic protein after seizures in children.
OBJECTIVE
To evaluate pediatric seizure patients for astrocytic injury by measuring cerebrospinal fluid (CSF) glial fibrillary acidic protein (GFAP), determine risk factors for GFAP elevation after seizures, and compare seizure-induced astrocyte injury with neuronal injury by concurrent measurement of CSF neuron-specific enolase (NSE).


METHODS
CSF obtained from pediatric patients (n = 52) within 24 h of seizure was assayed for GFAP and NSE. Retrospective chart review was performed for seizure type, duration, and etiology.


RESULTS
Overall, children with seizures had elevated CSF GFAP compared with controls (p = 0.0075), but no elevation of NSE (p = 0.1437). No effect of seizure type or etiology was found, but a significant positive effect of seizure duration (p = 0.0010) and status epilepticus (p = 0.0296) was seen on CSF GFAP. Individually, seven children (13%) had elevated GFAP (>440 pg/ml); in five children, the increased GFAP was not accompanied by elevations in NSE (<12 ng/ml). Five children with elevated GFAP had symptomatic etiologies for their seizures, but the etiology of one child with elevated GFAP was cryptogenic, and one had febrile seizures.


CONCLUSIONS
Elevation of CSF GFAP after seizures suggests that astrocytic injury may occur in a subgroup of children, primarily in the context of prolonged seizures and symptomatic etiologies. Increased GFAP levels may occur in patients with normal NSE, suggesting that GFAP may be a more sensitive marker of brain injury in some cases.
Gurnett
Christina A
CA
Department of Neurology, Washington University School of Medicine, St. Louis Children's Hospital, Missouri 63110-1093, USA.
Landt
Michael
M
Wong
Michael
M
D000293:Adolescent; D001253:Astrocytes / Q000502:physiology; D001925:Brain Damage, Chronic / Q000134:cerebrospinal fluid / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000134:cerebrospinal fluid*; D006801:Humans; D007223:Infant; D008297:Male; D009474:Neurons / Q000502:physiology; D010751:Phosphopyruvate Hydratase / Q000134:cerebrospinal fluid; D012307:Risk Factors; D013226:Status Epilepticus / Q000134:cerebrospinal fluid / Q000175:diagnosis
D005904:Glial Fibrillary Acidic Protein; D010751:Phosphopyruvate Hydratase