KASMEJ

Kastamonu Medical Journal regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

EndNote Style
Index
Original Article
Can immature granulocyte (IG), an inflammatory marker, be used in the differential diagnosis of epilepsy and non-epileptic psychogenic seizure?
Aims: Differential diagnosis of epilepsy and psychogenic non-epileptic seizures (PNES) is a great challenge. Intense neuronal activity during epileptic seizures can cause neuroinflammation. Immature granulocyte (IG) is a new inflammatory marker analyzed in hemogram. This study investigated the role of IG in differentiating epilepsy from PNES.
Methods: In this retrospective study, patients who applied to the emergency department for the first time with seizures and were diagnosed with epilepsy/PNES (clinical evaluation and electroencephalography) after included the seizure by the neurology clinical follow-up. Of the 84 patients, 54 had epilepsy, and 30 had PNES. Hemogram analyses were performed within 2 hours of the onset of the seizure.
Results: The IG count was 0.03 x109/L (0.02-0.06) and 0.03 x109/L (0.02-0.05) in the epilepsy and PNES groups, respectively. The two groups had no statistically significant difference (p=0.291). Only serum C-reactive protein (CRP) levels significantly differed between the two groups (p=0.031). The ROC curve analysis for the CRP test yielded a serum CRP value of 2.35 mg/L, with a sensitivity of 0.57 and a specificity of 0.73, as the optimal cut-off value for distinguishing epilepsy from PNES. The ROC analysis for the AUC yielded an estimate of 0.64 (95% confidence interval: 0.52-0.77).
Conclusion: In conclusion, only CRP was useful in differentiating epilepsy from PNES in the study. However, the IG count did not help to separate the two seizures. Therefore, these findings should be confirmed by further prospective studies with large samples assessing the IG count. This study evaluating the IG count, a new inflammatory marker, will contribute to the literature.


1. Pallin DJ, Goldstein JN, Moussally JS, Pelletier AJ, Green AR, CamargoCA Jr. Seizure visits in US emergency departments: epidemiology andpotential disparities in care. Int J Emerg Med. 2008;1(02):97-105.
2. Griffith NM, Szaflarski JP. Epidemiology and classification of psychogenicnonepileptic seizures. In: Gates JR, Rowan AJ, editors. Nonepilepticseizures. Cambridge: Cambridge University Press; 2010;3:16
3. Alsaadi TM, Marquez AV. Psychogenic Nonepileptic Seizures. Am FamPhysician. 2005;72(1):849-856.
4. Saxena S, Li S. Defeating epilepsy: a global public health commitment.Epilepsia Open. 2017;2(2):153-155.
5. Brown RJ, Trimble MR. Dissociative psychopathology, non-epilepticseizures, and neurology. J Neurol Neurosurg Psychiatry. 2000;69(3):285-289.
6. Karakas C, Modiano Y, Ness PCV, et al. Home video prediction of epilepticvs. nonepileptic seizures in US veterans. Epilepsy Behav. 2021;117:107811.
7. Morkavuk G, Koc G, Leventoglu A. Is the differential diagnosis ofepilepsy and psychogenic nonepileptic seizures possible by assessingthe neutrophil/lymphocyte ratio? Epilepsy Behav. 2021;116:107736.doi:10.1016/j.yebeh.2020.107736
8. Dey A, Kang Xu, Qiu J, Du Y, Jiang J. Anti-inflammatory small moleculesto treat seizures and epilepsy: from bench to bedside. Trends PharmacolSci. 2016;37(6):463-484.
9. Vezzani A, French J, Bartfai T, Baram TZ. The role of inflammation inepilepsy. Nat Rev Neurol. 2011;7(1):31-40.
10. Senthilnayagam B, Kumar T, Sukumaran J, M J, Rao K R. Automatedmeasurement of immature granulocytes: performance characteristics andutility in routine clinical practice. Patholog Res Int. 2012;2012:483670.doi:10.1155/2012/483670
11. Ansari-Lari MA, Kickler TS, Borowitz MJ. Immature granulocytemeasurement using the Sysmex XE-2100. Relationship to infection andsepsis. Am J Clin Pathol. 2003;120(5):795-799. doi:10.1309/LT30-BV9U-JJV9-CFHQ
12. Nigro KG, O’Riordan M, Molloy EJ, Walsh MC, Sandhaus LM. Performanceof an automated immature granulocyte count as a predictor of neonatalsepsis. Am J Clin Pathol. 2005;123(4):618-624. doi:10.1309/73H7-K7UB-W816-PBJ
13. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol.2005;91(3):181-184.
14. Warimwe GM, Murungi LM, Kamuyu G, et al. The ratio of monocytes tolymphocytes in peripheral blood correlates with increased susceptibilityto clinical malaria in Kenyan children. PLoS One. 2013;8(2):e57320.doi:10.1371/journal.pone.0057320
15. Merekoulias G, Alexopoulos EC, Belezos T, Panagiotopoulou E,Jelastopulu DM. Lymphocyte to monocyte ratio as a screening tool forinfluenza. PLoS Curr. 2010;2:RRN1154.
16. Smith RA, Bosonnet L, Ghaneh P, et al. The platelet-lymphocyte ratioimproves the predictive value of serum CA19-9 levels in determiningpatient selection for staging laparoscopy in suspected periampullarycancer. Surgery. 2008;143(5):658-666.
17. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predictsprognosis of patients after curative resection for hepatocellular carcinoma.Clin Cancer Res. 2014;20(23):6212-6222.
18. Jia CP, Chen H, Sun B. Zhonghua Wai Ke Za Zhi. 2019;57(11):862-865.doi:10.3760/cma.j.issn.0529-5815.2019.11.013
19. Vezzani A, Aronica E, Mazarati A, Pittman QJ. Epilepsy and braininflammation. Exp Neurol. 2013;244:11-21.
20. Vieira ÉLM, de Oliveira GNM, Lessa JMK, et al. Peripheral leukocyteprofile in people with temporal lobe epilepsy reflects the associatedproinflammatory state. Brain Behav Immun. 2016;53:123-130. doi:10.1016/j.bbi.2015.11.016
21. Terrone G, Balosso S, Pauletti A, Ravizza T, Vezzani A. Inflammation andreactive oxygen species as disease modifiers in epilepsy. Neuropharmacology.2020;167:107742. doi:10.1016/j.neuropharm.2019.107742
22. Korkut M, Bedel C, Zortuk Ö, Selvi F. Can immature granulocytesindicate mortality in patients with acute ischemic stroke? Neurology Asia.2021;26(4):665-670.
23. Bedel C, Korkut M, Selvi F, Zortuk Ö. The immature granulocytecount is a new predictor of the 30-day mortality in intracerebralhaemorrhage patients: preliminary study. Indian Journal of Neurosurgery.2021;10(02):114-120.
24. Kocatürk İ, Gülten S. Immature granulocyte and other markers inprediction of mortality in spontaneous intracerebral hemorrhage. Journalof Health Sciences and Medicine. 2023;6(2):368-373.
25. Aslan A, Cevik E. “Critical Analysis of Blood Parameters in EpilepsyPatients” 2020;11:193-196.
26. Güneş M, Büyükgöl H. Relationship between generalized epilepticseizure and neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, andneutrophil mediated inflammation. Int J Neurosci. 2020;130(11):1095-1100.
27. Faruk Ozdemir A, Kemerdere R, Orhan B, et al. Serum endocan andpreoperative systemic inflammatory markers in patients with epilepsy.Neurochirurgie. 2020;66(1):29-35.
28. Özdemir HH, Akil E, Acar A, et al. Changes in serum albumin levels andneutrophil-lymphocyte ratio in patients with convulsive status epilepticus.Int J Neurosci. 2017;127(5):417-420.
29. Li Y, Matzka L, Flahive J, Weber D. Potential use of leukocytosis and aniongap elevation in differentiating psychogenic nonepileptic seizures fromepileptic seizures. Epilepsia Open. 2019:30;4(1):210-215.
30. Kushner I. The phenomenon of the acute phase response. Ann NY AcadSci USA. 1982;389(1):39-48.
31. Doğan EA, Ünal A, Ünal A, Erdoğan Ç. Clinical utility of serum lactatelevels for differential diagnosis of generalized tonic-clonic seizuresfrom psychogenic nonepileptic seizures and syncope. Epilepsy Behav.2017;75:13-17.
32. Shah AK, Shein N, Fuerst D, Yangala R, Shah J, Watson C. Peripheral WBCcount and serum prolactin level in various seizure types and nonepilepticevents. Epilepsia. 2001;42(11):1472-1475.
33. Albadareen R, Gronseth G, Landazuri P, He J, Hammond N, Uysal U.Postictal ammonia as a biomarker for electrographic convulsive seizures:A prospective study. Epilepsia. 2016;57(8):1221-1227.
Volume 3, Issue 3, 2023
Page : 155-158
_Footer