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.