Lactate in seizures

Q: What is the utility of lactate level in seizures?

Answer: To differentiate between syncope, a generalized seizure & non-epileptic events

Clinical events may appear as underlying epilepsy, such as unwitnessed transient loss of consciousness (LOC), coma, or psychogenic nonepileptic seizure. Lactic acid level remain high for about two hours after a generalized seizure. It can be a good marker for differentiation from other recent neurological events.

Other labs though non-specific, which may help to make a diagnosis are high creatine phosphokinase (CPK), cortisol, leucocytosis, LDH, and neuron-specific enolase.

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References:

1. Matz O, Heckelmann J, Zechbauer S, et al. Early postictal serum lactate concentrations are superior to serum creatine kinase concentrations in distinguishing generalized tonic-clonic seizures from syncopes. Intern Emerg Med 2018; 13:749.

2. Doğan EA, Ünal A, Ünal A, Erdoğan Ç. Clinical utility of serum lactate levels for differential diagnosis of generalized tonic-clonic seizures from psychogenic nonepileptic seizures and syncope. Epilepsy Behav 2017; 75:13.

3. Magnusson C, Herlitz J, Höglind R, et al. Prehospital lactate levels in blood as a seizure biomarker: A multi-center observational study. Epilepsia 2021; 62:408.

4. Willert C, Spitzer C, Kusserow S, Runge U. Serum neuron-specific enolase, prolactin, and creatine kinase after epileptic and psychogenic non-epileptic seizures. Acta Neurol Scand 2004; 109:318.

5. Petramfar P, Yaghoobi E, Nemati R, Asadi-Pooya AA. Serum creatine phosphokinase is helpful in distinguishing generalized tonic-clonic seizures from psychogenic nonepileptic seizures and vasovagal syncope. Epilepsy Behav 2009; 15:330.