title: Effect of epileptic seizures on the cerebrospinal fluid--A systematic retrospective analysis.
abstract: OBJECTIVE
  Analyses of the cerebrospinal fluid (CSF) are obligatory when epileptic seizures manifest for the first time in order to exclude life-threatening causes or treatable diseases such as acute infections or autoimmune encephalitis. However, there are only few systematic investigations on the effect of seizures themselves on CSF parameters and the significance of these parameters in differential diagnosis.
  
  
  METHODS
  CSF samples of 309 patients with epileptic and 10 with psychogenic seizures were retrospectively analyzed. CSF samples were collected between 1999 and 2008. Cell counts, the albumin quotient, lactate and Tau-protein levels were determined. Findings were correlated with seizure types, seizure etiology (symptomatic, cryptogenic, occasional seizure), and seizure duration.
  
  
  RESULTS
  Pathological findings were only observed in patients with epileptic but not with psychogenic seizures. The lactate concentration was elevated in 14%, the albumin quotient in 34%, and the Tau protein level in 36% of CSF samples. Cell counts were only slightly elevated in 6% of patients. Different seizure types influenced all parameters except for the cell count: In status epilepticus highest, in simple partial seizures lowest values were seen. Symptomatic partial and generalized epileptic seizures had significantly higher Tau-protein levels than cryptogenic partial seizures. In patients with repetitive and occasional epileptic seizures, higher Tau-protein levels were seen than in those with psychogenic seizures. Duration of epileptic seizures was positively correlated with the albumin quotient, lactate and Tau-protein levels. High variability of investigated CSF parameters within each subgroup rendered a clear separation between epileptic and psychogenic seizures impossible.
  
  
  CONCLUSIONS
  Elevated cell counts are infrequently observed in patients with epileptic seizures and should therefore not uncritically be interpreted as a postictal phenomenon. However, blood-CSF barrier disruption, increased glucose metabolism and elevation of neuronal damage markers are observed in considerable percentages of patients and depend on many factors such as etiology, seizure type and duration.
authors.affiliation: Department of Neurology, University of Ulm, Germany. Electronic address: hayrettin.tumani@uni-ulm.de.
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Tumani
authors.affiliation: Department of Neurology, University of Ulm, Germany; Department of Neurology, Bezirkskrankenhaus Günzburg, Günzburg, Germany. Electronic address: cathy.jobs@web.de.
authors.forename: Catherine
authors.initials: C
authors.lastname: Jobs
authors.affiliation: Department of Neurology, University of Ulm, Germany; Center of Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, USA. Electronic address: johannes.brettschneider@uni-ulm.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brettschneider
authors.affiliation: Department of Neurology, Klinikum Heidenheim, Heidenheim an der Brenz, Germany. Electronic address: anselmhoppner@gmx.de.
authors.forename: Anselm C
authors.initials: AC
authors.lastname: Hoppner
authors.affiliation: Department of Neurology, Krankenhaus Rummelsberg gGmbH, Schwarzenbruck, Germany. Electronic address: Frank.Kerling@Sana.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Kerling
authors.affiliation: Department of Neurology, University of Ulm, Germany. Electronic address: susanne.fauser@uni-ulm.de.
authors.forename: Susanne
authors.initials: S
authors.lastname: Fauser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000134:cerebrospinal fluid; D002452:Cell Count; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000166:cytology; D004827:Epilepsy / Q000134:cerebrospinal fluid*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000134:cerebrospinal fluid*; D013226:Status Epilepticus / Q000134:cerebrospinal fluid; D055815:Young Adult; D016875:tau Proteins / Q000134:cerebrospinal fluid
chemical_list: D000418:Albumins; D016875:tau Proteins; D019344:Lactic Acid
keywords: Blood–CSF barrier; Cerebrospinal fluid; Epilepsy; neuronal damage