Impact of Early Lactate Dosage Compared to CK for Diagnosis of a Suspected Seizure
Impact of Early Lactate Dosage Compared to CK for Diagnosis of a Suspected Seizure
Defining the origin of a seizure remains a difficult diagnosis. The presence of witness is
 not systematic, the clinical examination can be little contributory, and the delay
 recommended by the FSN is often surpassed for the realization of Creatine kinase (4h). In the
 event of a suspected seizure, an initial blood test with Creatine kinase and Lactates is
 often done on admission of the patient in other words before the 4hours delay.

 It seems interesting to harmonize the practices, to limit the patient wait in the emergencies
 for a deferred dosage of CK at 4 hours from the seizure and to identify an early biological
 marker.

 Objectives:

 To evaluate the value of blood CK and Lactate dosage in emergency procedures in the diagnosis
 of generalized seizures.
We propose to carry out a prospective, observational, monocentric study at the CHU of
 Clermont-Ferrand. This is a descriptive analysis of the kinetics of the Creatine kinase and
 Lactates rates collected at the admission of a patient consulting for strong suspicion of
 convulsive seizure, and at 4 hours from the generalized seizure.

 A patient consulting the emergency department for suspected seizure will have an usual blood
 test at the admission in this context with notably ionogram, fasting glucose, venous
 gasometry. As the CHU purchased a venous and arterial gasometry reader for the emergency
 department, blood ionogram, Hb, lactates, HCO3-, pH are collected without delay.

 The Creatine kinase dosage will be collected in the usual way as a "tube bottom".

 As recommended by the French Society of Neurology, a new sample will be collected at 4 hours
 of seizure for a dosage of Creatine kinase. The determination of the lactates will be based
 on a "tube bottom".

 It is the emergency practitioner who will decide whether or not to include the patient in the
 descriptive study, assisted by a standardized survey, enumerating the high probability of
 generalized seizure orientation characteristics (patient history, treatments including
 antiepileptics, anamnesis, witnesses presence, evocative clinic) The study only recruited
 cases of strong suspicion of generalized seizure, beginning less than 4 hours to compare the
 kinetics of Creatine kinase and Lactates at admission and 4 hours of the generalized seizure.
Inclusion Criteria:

 -  Any generalized convulsive seizure defined by a transient loss of consciousness with
 the occurrence of tonic-clonic movements.

 -  Beginning less than 4 hours.

 -  In a highly evocative context of the crisis by the presence of: witnesses and/or Urine
 loss, Tongue bite and/or personal medical history of epilepsy and/or Favorable
 context: sleeping debt, drug withdrawal, lights stimulations, video games and/or
 Impression of "already lived", already experienced before the discomfort and/or Break
 contact, and/or Unusual posture with hypertonia and/or Amnesia of the episode and/or
 Post-episode Confusion

 -  Inaugural or recurrent

 Exclusion Criteria:

 -  Patient Refusal

 -  <18 years

 -  Pregnancy

 -  Sepsis, fever> 38 °

 -  Shock State

 -  Myocardial infarction

 -  Unbalanced Diabetes

 -  Hepatocellular insufficiency

 -  Drug and Toxic Use

 -  Taking Metformin

 -  Significant muscle injuries

 -  Myopathy