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Home > Archives > Volume 20, No 8 (2022) > Article

DOI: 10.14704/nq.2022.20.8.NQ44065

Role of Creatine Kinase in Differentiating Tonic Clonic from Psychogenic Non-Epileptic Seizures in Emergency Department - Suez Canal University Hospital

Maria Adly Shalaby kamel, Mohamed Ebrahim Negm, Nashwa M. Abdelgeleel, Rasha M. Ahmed, khaled Morsy Salama


Introduction: Psychogenic nonepileptic seizures are form of conversion disorder as paroxysmal episodes resembling epileptic seizures while lacking electroencephalogram correlation. Creatinine kinase (CK) is a muscle specific enzyme which may be useful marker for differentiation of psychogenic non epileptic seizures from generalized tonic colonic seizures. Aim: To assess the ability of serum levels of CK in differentiation between Generalized tonic-clonic seizures (GTCS) and Psychogenic nonepileptic seizures (PNES). Patients and methods: A prospective cohort study was conducted on 20 patients with GTCS and 20 patients with PNES who were presented in Suez Canal University Hospital. All patients were subjected to Initial assessment includes: History, clinical Examination, laboratory investigation, Radiographic: assessment. Serum CK in blood samples were drawn within 2 hrs., and 24 hrs. of the event from patients in both groups. Results: The current study found statistically significant older age with psychogenic non epileptic seizures compared to GTCS with p-value=0.037, 75% of patients with GTCS had positive EEG findings while only 10% of PNES had positive EEG findings, there was statistically significant higher CK level in GTCS compared to psychogenic non epileptic seizures with p-value <0.001. CK after 2h had 90% sensitivity, 85% specificity, AUC 0.926 at cutoff point 120 U/L and 90% sensitivity, 95% specificity, at cut off point 156 U/L for diagnosis of GNTS. Conclusion: Serum creatinine kinase can used in differentiation between psychogenic non epileptic seizures and generalized tonic colonic seizures, it had the advantage of continuous discharge even through 24 hours after seizures.


Video electroencephalography, Reflex

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