Ali CANSU, Hepsen Mine SERİN, Tülay KAMAŞAK, Ahmet ALVER, Ahmet MENTEŞE, Süleyman TÜREDİ, Abdülkadir GÜNDÜZ

Can ischemia-modified albumin be used to differentiate between generalized seizures and pseudoseizures?

Background/aim: In recent years ischemia-modified albumin (IMA) has been suggested as a marker that can be used in differentiating nonconvulsive conditions from epilepsy. The purpose of this study was to investigate changes in IMA levels caused by generalized clonic tonic (GTC) seizures. Materials and methods: A total of 114 children presenting to the Karadeniz Technical Pediatric Emergency Polyclinic with GTC seizures were included in the study. Sixteen cases meeting the inclusion criteria were included in the study and sixteen healthy children were enrolled as the control group. The patients IMA, albumin, and IMA/albumin values at hours 0 and 1 following the episode were compared with control group values. Results: IMA levels in the patient group were significantly higher at hour 1 compared to hour 0, and were also significantly higher than those of the control group levels at hour 1. In addition, the patient group IMA/albumin index value at hour 1 was significantly higher than the baseline value. IMA levels increased significantly with length of seizure. Conclusion: Although there were no markers of hypoxia in patients undergoing GTC seizures in this study, hypoxia was observed to develop, and this caused serum IMA levels to rise in line with seizure duration.

PDF

___

1. Lippi G, Montagnana M. Ischemia-modified albumin in ischemic disorders. Ann Thorac Cardiovasc Surg 2009; 15: 137.
2. Apple FS, Wu AH, Mair J, Ravkilde J, Panteghini M, Tate J, Pagani F, Christenson RH, Mockel M, Danne O et al. Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Clin Chem 2005; 51: 810-824.
3. Apple FS, Quist HE, Otto AP, Mathews WE, Murakami MM. Release characteristics of cardiac biomarkers and ischemiamodified albumin as measured by the albumin cobalt-binding test after a marathon race. Clin Chem 2002; 48: 1097-1100.
4. Dundar ZD, Cander B, Gul M, Karabulut KU, Girisgin S. Serum ischemia-modified albumin levels in an experimental acute mesenteric ischemia model. Acad Emerg Med 2010; 17: 1233-1238.
5. Gunduz A, Turedi S, Mentese A, Altunayoglu V, Turan I, Karahan SC, Topbas M, Aydın M, Eraydin I, Akcan B. Ischemiamodified albumin levels in cerebrovascular accidents. Am J Emerg Med 2008; 26: 874-878.
6. Lippi G, Salvagno GL, Montagnana M, Schena F, Ballestrieri F, Guidi GC. Influence of physical exercise and relationship with biochemical variables of NT-pro-brain natriuretic peptide and ischemia modified albumin. Clin Chim Acta 2006; 367: 175- 180.
7. Sacchetti A. Ischemia modified albumin: a new biochemical marker of myocardial ischaemia. Emerg Med J 2004; 21: 3-4.
8. Sinha MK, Gaze DC, Tippins JR, Collinson PO, Kaski JC. Ischemia modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation 2003; 107: 2403-2405.
9. Talwalkar SS, Bon Homme M, Miller JJ, Elin RJ. Ischemia modified albumin, a marker of acute ischemic events: a pilot study. Ann Clin Lab Sci 2008; 38: 132-137.
10. Quiles J, Roy D, Gaze D, Garrido IP, Avanzas P, Sinha M, Kaski JC. Relation of ischemia-modified albumin (IMA) levels following elective angioplasty for stable angina pectoris to duration of balloon-induced myocardial ischemia. Am J Cardiol 2003; 92: 322-324.
11. Huff JS, Fountain NB. Pathophysiology and definitions of seizures and status epilepticus. Emerg Med Clin North Am 2011; 29: 1-13.
12. Bateman LM, Li CS, Seyal M. Ictal hypoxemia in localizationrelated epilepsy: analysis of incidence, severity and risk factors. Brain 2008; 131: 3239-3245.
13. Moseley BD, Nickels K, Britton J, Wirrell E. How common is ictal hypoxemia and bradycardia in children with partial complex and generalized convulsive seizures? Epilepsia 2010; 51: 1219-1224.
14. Blennow G, Brierley JB, Meldrum BS, Siesjö BK. Epileptic brain damage: the role of systemic factors that modify cerebral energy metabolism. Brain 1978; 101: 687-700.
15. Bar-Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med 2000; 19: 311-315.
16. Pollack CV, Peacock FW, Summers RW, Fesmire FM, Holroyd BR. Ischemia-modified albumin (IMA) is useful in risk stratification of emergency department chest pain patients. Acad Emerg Med 2003; 10: 555-556.
17. Turedi S, Cinar O, Kaldirim U, Mentese A, Tatli O, Cevik E, Tuncer SK, Gunduz A, Yamanel L, Karahan SC. Ischemiamodified albumin levels in carbon monoxide poisoning. Am J Emerg Med 2011; 29: 675-681.
18. Abboud H, Labreuche J, Meseguer E, Lavallee PC, Simon O, Olivot JM, Mazighi M, Dehoux M, Benessiano J, Steg PG et al. Ischemia-modified albumin in acute stroke. Cerebrovasc Dis 2007; 23: 216-220.
19. Ahn JH, Choi SC, Lee WG, Jung YS. The usefulness of albuminadjusted ischemia-modified albumin index as early detecting marker for ischemic stroke. Neurol Sci 2011; 32: 133-138.
20. Haklıgör A, Kösem A, Seneş M, Yücel D. Effect of albumin concentration and serum matrix on ischemia-modified albumin. Clin Biochem 2010; 43: 345-348.
21. Kim JS, Hwang HJ, Ko YG, Kim JS, Choi D, Ha JW, Hong MK, Jang Y. Ischemia-modified albumin: is it a reliable diagnostic and prognostic marker for myocardial ischemia in real clinical practice? Cardiology 2010; 116: 123-129.
22. Herisson F, Delaroche O, Auffray-Calvier E, Duport BD, Guillon B. Ischemia-modified albumin and heart fatty acidbinding protein: could early ischemic cardiac biomarkers be used in acute stroke management? J Stroke Cerebrovasc Dis 2010; 19: 279-282.
23. Sbarouni E, Georgiadou P, Kremastinos DT, Voudris V. Ischemia modified albumin: is this marker of ischemia ready for prime time use? Hellenic J Cardiol 2008; 49: 260-266.