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Vol. 64, No. 1, 2010
Issue release date: July 2010

Postictal Transient Hyperammonemia as an Indicator of Seizure Disorder

Liu K.-T. · Lee C.-W. · Yang S.-C. · Yeh I-J. · Lin T.-J. · Su C.-S.
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Abstract

Background and Purpose: Transient hyperammonemia can occur after episodes of seizure. To verify that transient hyperammonemia is a unique finding in seizure patients, we compared the change in blood ammonia concentration during the postictal period with that of other patients who suffered consciousness disturbances due to other disorders. Methods: We compared the results of a biochemical examination, including serum ammonia levels, between adult patients sent to the emergency department (ED) with seizure and those with other causes of consciousness disturbance. Results: Nineteen out of 31 patients with generalized epileptic seizures showed hyperammonemia at initial data measurement. Seventeen of these patients showed transient hyperammonemia. Only 10 patients with hepatic encephalopathy showed hyperammonemia, while none of the patients suffering from other causes of consciousness disturbance showed transient hyperammonemia within hours of arrival at the ED. Conclusion: Transient hyperammonemia was observed in the majority of generalized tonic-clonic seizure patients examined in this study but not in those with other causes of consciousness disturbance. Because ammonia is checked in patients presenting with transient consciousness disturbance to the ED, with or without witness, transient hyperammonemia could be an indicator of recent epileptic seizure.



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References

  1. Chen DK, So YT, Fisher RS, Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology: Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2005;65:668–675.
  2. Wyllie E, Lueders H, Pippenger C, VanLente F: Postictal serum creatine kinase in the diagnosis of seizure disorders. Arch Neurol 1985;42:123–126.
  3. Liu KT, Su CS: Postictal transient hyperammonemia. Am J Emerg Med 2008;26:388.e381–388.e382.

    External Resources

  4. Yanagawa Y, Nishi K, Sakamoto T: Hyperammonemia is associated with generalized convulsion. Intern Med 2008;47:21–23.
  5. Lowenstein J, Tornheim K: Ammonia production in muscle: the purine nucleotide cycle. Science 1971;171:397–400.
  6. Brouns F, Beckers E, Wagenmakers AJM, Saris WHM: Ammonia accumulation during highly intensive long-lasting cycling: individual observations. Int J Sports Med 1990;11(suppl 2):S78–S84.
  7. Katayama K: Ammonia metabolism and hepatic encephalopathy. Hepatol Res 2004;30(suppl 1):73–80.

    External Resources



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