Concentrations of serum creatine kinase (CK) and serum lactate are frequently measured to help differentiate between generalized tonic–clonic seizures (GTCS) and syncope. The aim of this prospective cohort study was to systematically compare these two markers. The primary outcome is the measurement of serum lactate and CK in blood samples drawn within 2 h of the event in patients admitted with either a GTCS (n = 49) or a syncope (n = 36). Furthermore, the specificity and sensitivity of serum lactate and CK are determined as diagnostic markers in distinguishing between GTCS and syncope. GTCS patients have significantly higher serum lactate levels compared to syncope patients (p < 0.001). In contrast, CK does not differ between groups at admission. Regarding the first hour after the seizure, we identify a cut-off for serum lactate of 2.45 mmol/l for diagnosing GTCS as the cause of an impairment of consciousness with a sensitivity of 0.94 and a specificity of 0.93 (AUC: 0.97; 95% CI 0.94–1.0). In the second hour after the event, the ROC analysis yields similar results (AUC: 0.94; 95% CI 0.85–1.0). Serum lactate is a sensitive and specific diagnostic marker to discriminate GTCS from syncope and is superior to CK early after admission to the emergency department.
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We gratefully acknowledge comments from Dr. Laura Hausmann (PhD).
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to declare.
Statement of human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Chowdhury FA, Nashef L, Elwes RD (2008) Misdiagnosis in epilepsy: a review and recognition of diagnostic uncertainty. Eur J Neurol 15:1034–1042CrossRefPubMedGoogle Scholar
Chesson AL, Kasarskis EJ, Small VW (1983) Postictal elevation of serum creatine kinase level. Arch Neurol 40:315–317CrossRefPubMedGoogle Scholar
Orringer CE, Eustace JC, Wunsch CD et al (1977) Natural history of lactic acidosis after grand-mal seizures. A model for the study of an anion-gap acidosis not associated with hyperkalemia. N Engl J Med 297:796–799CrossRefPubMedGoogle Scholar
Matz O, Zdebik C, Zechbauer S et al (2016) Lactate as a diagnostic marker in transient loss of consciousness. Seizure 40:71–75CrossRefPubMedGoogle Scholar
Faul F, Erdfelder E, Lang AG et al (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191CrossRefPubMedPubMedCentralGoogle Scholar
Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36CrossRefGoogle Scholar
Neufeld MY, Treves TA, Chistik V et al (1997) Sequential serum creatine kinase determination differentiates vaso-vagal syncope from generalized tonic-clonic seizures. Acta Neurol Scand 95:137–139CrossRefPubMedGoogle Scholar
Mahmoud AT, El Deghady AA (2005) Serum prolactin and creatine kinase levels in epileptic and non epileptic seizures. Alex J Pediatr 19:217–222Google Scholar
Libman MD, Potvin L, Coupal L (1991) Seizure vs. syncope: measuring serum creatine kinase in the emergency department. J Gen Intern Med 6:408–412CrossRefPubMedGoogle Scholar
Broder G, Weil MH (1964) Excess lactate: an index of reversibility of shock in human patients. Science 143:1457–1459CrossRefPubMedGoogle Scholar
Attana P, Lazzeri C, Chiostri M et al (2012) Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: a pilot study. Acute card care 14:20–26CrossRefPubMedGoogle Scholar
Akkose S, Ozgurer A, Bulut M et al (2007) Relationships between markers of inflammation, severity of injury, and clinical outcomes in hemorrhagic shock. Adv Ther 24:955–962CrossRefPubMedGoogle Scholar
Jeng JC, Jablonski K, Bridgeman A et al (2002) Serum lactate, not base deficit, rapidly predicts survival after major burns. Burns 28:161–166CrossRefPubMedGoogle Scholar
Khan FY (2009) Rhabdomyolysis: a review of the literature. Neth J Med 67:272–283PubMedGoogle Scholar
Benzon HT, Toleikis JR, Meagher LL et al (1988) Changes in venous blood lactate, venous blood gases, and somatosensory evoked potentials after tourniquet application. Anesthesiology 69:677–682CrossRefPubMedGoogle Scholar
Kaplan LJ, Kellum JA (2004) Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med 32:1120–1124CrossRefPubMedGoogle Scholar
Puskarich MA, Trzeciak S, Shapiro NI et al (2012) Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation. Acad Emerg Med 19:252–258CrossRefPubMedPubMedCentralGoogle Scholar
Chiolero RL, Revelly JP, Leverve X et al (2000) Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery. Crit Care Med 28:3784–3791CrossRefPubMedGoogle Scholar
Stang M, Wysowski DK, Butler-Jones D (1999) Incidence of lactic acidosis in metformin users. Diabetes Care 22:925–927CrossRefPubMedGoogle Scholar
Record CO, Chase RA, Williams R et al (1981) Disturbances of lactate metabolism in patients with liver damage due to paracetamol overdose. Metabolism 30:638–643CrossRefPubMedGoogle Scholar
Almenoff PL, Leavy J, Weil MH et al (1989) Prolongation of the half-life of lactate after maximal exercise in patients with hepatic dysfunction. Crit Care Med 17:870–873CrossRefPubMedGoogle Scholar