Serum Ammonia as a Biomarker to Differentiate Between True Epileptic and Psychogenic Non-epileptic Seizures: A Cross-sectional Study.

Abstract

Background: A kind of conversion condition known as psychogenic non-epileptic seizures (PNES) is characterised by brief episodes that resemble epileptic fits but lack electroencephalographic (EEG) confirmation. Although the clinical history plays a significant role in the seizure diagnosis, imaging and serum markers are included in the initial evaluation for patients who present to the emergency.

Objectives: To validate the prevalence of serum ammonia as a biomarker in differentiating true epileptic and non-epileptic seizures.

Material methods: The study was a hospital-based observational, prospective comparative study spanning over 2 years after surpassing the patient consent, inclusion and exclusion criteria.

Results: The mean of the study participants were middle-aged, males predominant in IES and females in PNES. A slightly higher proportion of the patients in the IES group had episodes of less than 5 minutes in the PNES group, where episodes lasted between 5 to 10 minutes. Awareness of symptoms was observed more frequently in the PNES group. The area under the curve (AUC) for the serum ammonia level at arrival was 0.972 (95% CI: 0.94-0.99) with a P value of < .001.

Conclusion: Mean serum ammonia levels at arrival and after 48 hours of admissions in the idiopathic epileptic seizure group were significantly higher compared to the PNES group with P value < .001, validating its use as a biomarker.