Publication: Epileptik nöbet sırasında ölçülen çinko ve bakır düzeylerinin değerlendirilmesi / Evaluation of zinc and copper levels measured during epileptic seizure
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MEHMETAJ, LILJANA
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Giriş ve Amaç: Epilepsi, dünyada yaklaşık 50-65 milyondan fazla insanı etkileyen yaygın görülen nörolojik bir hastalıktır. Epilepsiyi ortaya çıkaran mekanizmalar çok faktörlüdür. Farmokolojik olarak epilepsi kontrol altına alınabilse de hastaların yaklaşık üçte birinde tedaviye dirençli hale gelmiştir bu sebeple yeni yaklaşımlara ihtiyaç duyulmaktadır. Epileptik nöbet ile acile başvuru yapan hastalarında bulunabilecek bir çinko ve bakır eksikliği, kişinin kullanmış olduğu antiepileptik ilaçların yan etkisi, düzensiz ilaç kullanımı, polifarmasi, gastrointestinal emilim bozukluğu ya da sosyoekonomik durumlardan kaynaklanan bir durum olabilir. Bu çalışmada hedefimiz eser element eksikliğinin epileptogenez ile ilişkisini saptamak, bu alanda araştırmaların geliştirilmesine katkıda bulunmaktır. Böylelikle epilepsi hastalarında meydana gelebilecek atak nöbetleri engelleme stratejileri oluşturup, epilepsi hastaların yaşam kalitesini iyileştirmektir. Gereç ve Yöntem: Araştırmamız Bezmialem Vakıf Üniversitesi Tıp Fakültesi Hastanesi Acil servis Anabilim Dalı 02.10.2019- 01.10.2020 tarihler arası prospektif olarak yapıldı. Epileptil nöbet ile acil servise gelen 65 hasta ve aile hekimliği polikliniğine sağlık kontrolü amacı ile gelmiş, tamamen sağlıklı olup ek hastalık ve ilaç kullanım öyküsü olmayan 65 gönüllü bireyin katılımı olmak üzere toplam 130 kişinin verileri incelendi. Çalışma için iki grup oluşturuldu; Hasta gurubu: Epileptik nöbet ile gelen, Sağlıklı kontrol gurubu: Herhangi bir hastalığa sahip olmayan, ilaç kullanmayan gönüllü bireylerden oluştu. Hastaların epileptik nöbet esnasında veya postiktal döneminde ilk 5-10 dakikada herhangi bir tedavi uygulamadan kan tahlilleri alınarak serumda eser elementler (Zn, Cu) analiz edildi. Hastaların anamnez ve demografik bulguları hazırladığımız formlara kaydedildi. Tüm olgular için istatistiksel anlamlılık p<0.05 olarak belirlendi. İstatistiksel analizler IBM SPSS (Windows için Sosyal Bilimler için İstatistik Paketi, Sürüm 21.0, Armonk, NY, IBM Corp.) paket programı ile sağlandı. Bulgular: Çalışma Bezmialem Vakıf Üniversitesi Tıp Fakültesi Hastanesi Acil Servis Anabilim Dalı'na nöbet ön tansı ile başvuran 83 hastayla başlandı. Hastalardan 4'ü sınıflandırılamayan nöbet grubu ve 14'ü EEG ve/veya diğer tanısal parametrelerle epileptik nöbet tanısı konmayarakçalışmadan çıkarıldı. Geriye kalan 65 epileptik nöbet geçiren hasta ve 65 sağlıklı gönüllü kişilerle çalışmaya devam edildi. Demografik özellikleri incelendiğinde nöbet gurubundaki (NG) 65 hastanın 29'u (44.61%) kadın, 36'sı (55.38%) erkektir. Sağlıklı gurubun (SG) 33'ü (50.8%) kadın, 32'si (49.2%) erkektir. NG ortalama yaş 43.75±19.49 yıl iken, SG ortalama yaşı 42.88±18.92 yıl olup istatiksel olarak anlamlı fark saptanmadı (p>0.78). NG serum Cu düzeyi 98.41±31.5 μg/dL iken, SG serum Cu düzeyi 108.11±19.09 μg/dL olup istatiksel olarak anlamlı fark saptandı (p=0.02). Fokal nöbet gurubunda (FNG) (105.17±32.75 μg/dL) ve SG (108.11±19.09 μg/dL) serum Cu düzeyi, jeneralize nöbet gurubuna (JNG) (86.88±26.0 μg/dL) oranla daha yüksek olup istatiksel olarak anlamlı saptandı (p=0.003). NG serum Zn düzeyi 72.59±20.87 ug/dl, SG serum Zn düzeyi 96.69±10.21 ug/dl olarak saptandı ve istatiksel olarak anlamlı fark mevcuttu (p<0.001). FNG serum Zn düzeyi (76.5±19.37 ug/dl) ve JNG serum Zn düzeyinin (65.92±22.02 ug/dl) her ikiside SG serum Zn düzeyine (96.69±10.21 ug/dl) göre istatiksel olarak anlamlı düşük gözlendi (p<0.001). Antiepileptik ilaç (AEİ) tedavisi kullanan hastalarda serum Cu düzeyi (95.38±31.27 μg/dL iken, AEİ kullanmayan hastalarda serum Cu düzeyi 110.54±30.66 μg/dL bulunumuş olup aralarında istatistiksel anlamlı fark vardı (p=0.009). AEİ kullanan hastalarda serum Zn düzeyi 70.82±22.35 μg/dL iken, AEİ kullanmayan hastalarda serum Zn düzeyi 79.69±11.44 ug/dl olarak saptanmış olup aralarında istatiksel olarak anlamlı fark vardı (p<0.001). Sonuç: Sonuç olarak Cu ve Zn elementlerinin nöbet geçirme esnasındaki seviyeleri sağlıklı guruba göre anlamlı düzeyde düşük bulundu (p=0.02, <0.001). Zn düzeyi hem FNG, hem de JNG'de SG'ye göre anlamlı seviyede düşük gözlenirken (p<0.001), Cu düzeyi sadece JNG gurubunda SG'ye göre anlamlı seviyede düşük saptandı (p=0.003). AEİ tedavisi alanlar, AEİ tedavisi almayanlara göre anlamlı olarak düşük seviyelerde Cu ve Zn düzeyleri tespit edilirken, bu ilaçlardan sadece karbamazepin tedavisi alan hastalarda ise en fazla Zn düzeyi düşüklüğü tespit edildi. Nöbet esnasındaki bu eser element seviyeleri nöbetsiz tanılı hastalardaki seviyeler ile genel olarak benzer şekilde düşük bulundu. Anahtar Kelimeler: Epilepsi, Çinko düzeyi, Bakır düzeyi
Description
Introduction and Aim: Epilepsy is a common neurological disease that affects approximately 50-65 million people worldwide. Mechanisms revealing epilepsy are multifactorial. Although epilepsy could be controlled pharmacologically, it became resistant to treatment in approximately one third of patients, so new approaches are needed. A zinc deficiency that may be found in patients presenting to the emergency department with epileptic seizures may be a side effect of the antiepileptic drugs used by the person, irregular drug use, polypharmacy, gastrointestinal malabsorption, or a condition resulting from socioeconomic conditions. Our aim in this study is to determine the relationship between trace element deficiency and epileptogenesis and to contribute to the development of research in this field. Thus, it is to create strategies to prevent attacks that may occur in epilepsy patients and to improve the quality of life of epilepsy patients. Methods: Our research was conducted prospectively between 02.10.2019- 01.10.2020, Bezmialem Vakıf University Faculty of Medicine Hospital Emergency Department. The data of a total of 130 individuals, including 65 patients who came to the emergency department with epileptic seizures and 65 volunteers who came to the family medicine outpatient clinic for health check-up, who were completely healthy and had no history of additional disease or drug use, were analyzed. Two groups were formed for the study; Patient group: presenting with epileptic seizure, The healthy control group: consisted of individuals who did not have any disease, did not use drugs, were the same age/sex as the patients and participated in the study voluntarily. In patients presenting with epileptic seizures, routine blood tests were taken during the epileptic seizure or in the first 5-10 minutes of the postictal period, without any antiepileptic administration. Trace elements (Zn, Cu) were then analyzed from these blood tests. On the other hand, the findings of the patients were recorded on the forms we prepared. Statistical significance was determined as p<0.05 for all cases. Statistical analyzes were provided with the IBM SPSS (Statistics Package for Social Sciences for Windows, Version 21.0, Armonk, NY, IBM Corp.) Results: The study was initiated with 83 patients who applied to the Emergency Department of Bezmialem Vakıf University Medical Faculty Hospital with a pre-diagnosis of seizures. Four of the patients were excluded from the study because they were diagnosed with an unclassifiable seizure group and 14 were not diagnosed with epileptic seizures by EEG and/or other diagnostic parameters. The study continued with the remaining 65 patients with epileptic seizure and 65 healthy volunteers. When their demographic characteristics were examined, 29 (44.61%) of 65 patients in the seizure group (SG) were female and 36 (55.38%) were male. In the healthy group (HG), 33 (50.8%) were female and 32 (49.2%) were male. While the mean age of SG was 43.75±19.49 years, the mean age of HG was 42.88±18.92 years, and no statistically significant difference was found (p>0.78). While SG serum Cu level was 98.41±31.5 μg/dL, HG serum Cu level was 108.11±19.09 μg/dL, and a statistically significant difference was found (p=0.02). Serum Cu level in the focal seizure group (FSG) (105.17±32.75 μg/dL) and HG (108.11±19.09 μg/dL) were higher than the generalized seizure group (GSG) (86.88±26.0 μg/dL) and were found to be statistically significant (p=0.003). SG serum Zn level was 72.59±20.87 ug/dl, HG serum Zn level was 96.69±10.21 ug/dl, and there was a statistically significant difference (p<0.001). FNG serum Zn level (76.5±19.37 ug/dl) and JNG serum Zn level (65.92±22.02 ug/dl) were both statistically significantly lower than SG serum Zn level (96.69±10.21 ug/dl) (p<0.001). While serum Cu level was 95.38±31.27 μg/dL in patients using antiepileptic drug (AED) treatment, serum Cu level was 110.54±30.66 μg/dL in patients not using AEDs, and there was a statistically significant difference between them (p=0.009). While serum Zn level was 70.82±22.35 μg/dL in patients using AEDs, serum Zn level was 79.69±11.44 ug/dl in patients not using AEDs, and there was a statistically significant difference between them (p<0.001). Conclusion: As a result, the levels of Cu and Zn elements during seizure were found to be significantly lower than the healthy group (p=0.02, <0.001). While the Zn level was significantly low in both FSG and GSG compared to HG (p<0.001), the Cu level was found to be significantly low only in the GSG group compared to HG (p=0.003). While significantly lower levels of Cu and Zn were detected in those who receiving AED treatment compared to those who did not receive AED treatment, the lowest Zn levels were detected in patients who received only carbamazepine treatment from these drugs. The levels of these trace elements during seizures were found to be generally low, similar to the levels in patients diagnosed without seizures. Keywords: Epilepsy, Zinc level, Copper leve