Role of Creatine Phosphokinase in Differentiating Epileptic Seizures and Psychogenic Non Epileptic Seizures

Abstract

Background: A seizure is an excessive abnormal hyper synchronous activity in the brain. Psychogenic Non epileptic seizures (PNES) are paroxysmal events that resemble seizures but are not associated with abnormal cortical activity and have a psychological origin. Multidisciplinary evaluation with video EEG even though diagnostic for these conditions; limitations in the availability and lack of changes in scalp EEG in all epileptic seizures might lead to misdiagnosis translating into inappropriate anticonvulsant therapy. Estimation of biomarkers like Creatine Phosphokinase (CPK) could be a readily available and cost-effective alternative. The objective was to determine the sensitivity and specificity of Creatine Phosphokinase in differentiating epileptic seizures from psychogenic non epileptic seizures in a patient presenting with new onset seizures.

Methodology: All patients presenting with new onset seizures in Department of General Medicine ward and casualty of Government Medical College, Kottayam were included in the study conducted over a period of 12 months. The patients were diagnosed with epileptic seizures or PNES using targeted investigations. The CPK levels were estimated and correlated with the diagnosis.

Results: Of the 60 participants, 43 (71.7%) presented with epileptic seizures and 17(28.3%) presented with PNES. There was a significant association of elevated mean CPK levels with epileptic seizures compared to PNES (1118±967.62 versus 172.23± 71.56). CPK had a sensitivity of 100% and specificity of52.94% in differentiating epileptic seizures and PNES.

Conclusion: Creatinine Phosphokinase can be considered as a biomarker with excellent sensitivity in differentiating epileptic seizures and PNES.