Case Report
From January 2022 to January 2023, we observed six patients who experienced significant CK elevations after seizure onset. Five patients exhibited CK > 5,000 U/L within three days after admission. As shown in Table 1 (Part I), there were four males and two females, and the age range was 16 to 68 years. Only patient 6 was currently consuming alcohol. Concerning the patients’ disease history, three patients had hypertension, and one patient had autoimmune encephalitis. The other patients did not have any history of prior major disease. All patients had no history of statin usage. The patients also did not exhibit any significant fever, hyperventilation, tachycardia, or hyperpiesia at admission.
The patients’ seizure histories are shown in Table 2. Patient 2 had been diagnosed with epilepsy for six months, and he had been taking sodium valproate. Four patients had probable provoked indications before seizures [14], including bowel preparations, vaccination, vomiting, or diarrhea. Based on the diagnostic criteria for seizures proposed by the International League Against Epilepsy [6], motor signs were described as tonic or tonic-clonic in two patients. The seizures were described as “convulsions” in the other patients, as medical history providers could not describe “tonic,” “clonic,” or “myoclonic” precisely. All patients displayed impaired awareness during their seizures, and four had recurring seizures. However, only patient 4 had a recurrence with impaired interictal awareness. The seizure duration for all patients was a maximum of five minutes. No epileptiform discharges were observed on video electroencephalogram (VEEG) after admission for any of the patients. Magnetic resonance imaging indicated that only patient 2 exhibited a brain lesion in the left frontal lobe that was a probable epileptic focus [14].
We summarized the results from the laboratory tests for CK, myoglobin, electrolytes, and the estimated glomerular filtration rate (eGFR) because we focused on the seizure-induced elevation of CK and its complications. The interval between the first onset to admission (IT) ranged from one to three days. As shown in Table 1 (Part II) and Figure 1, the CK levels increased gradually starting on the first day, peaked at three to five days, and decreased significantly at six to seven days. The CK levels may return to normal ten days after seizures. The level of CK was greater than 5,000 U/L in five of the six patients and the highest CK level was 39,300 U/L in patient 2. Significantly elevated myoglobin (4,194 μg/L) was observed in patient 5. However, there was no positive correlation between the elevated CK and myoglobin. The eGFR was calculated using an equation validated in the Chinese population [15]. Three patients exhibited an eGFR < 90 ml/min/1.73m2 and one patient had an eGFR < 60 ml/min/1.73m2 on admission. There were several significant electrolyte disorders in patients 4 and 6, who had hyponatremia, hypokalemia, or hypomagnesemia.
The treatment protocols are presented in Table 3. We used conservative measures to prevent AKI, which might be induced by muscle damage, including fluid resuscitation, urine alkalization, and diuretic agents. The CK levels in all patients decreased significantly during treatment after admission, and they exhibited a higher eGFR at discharge compared to their eGFR at admission.