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Table of Contents    
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTER TO EDITOR
Year : 2017  |  Volume : 65  |  Issue : 7  |  Page : 93-94

A single seizure attack induced rhabdomyolysis


Department of Neurology, First Affiliated Hospital, Zhejiang University, Hangzhou, China

Date of Web Publication8-Mar-2017

Correspondence Address:
Guoping Peng
Department of Neurology, First Affiliated Hospital, Zhejiang University, 79 Qingchun Road, Hangzhou - - 310003
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_1097_15

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How to cite this article:
Zhou J, Luo B, Peng G. A single seizure attack induced rhabdomyolysis. Neurol India 2017;65, Suppl S1:93-4

How to cite this URL:
Zhou J, Luo B, Peng G. A single seizure attack induced rhabdomyolysis. Neurol India [serial online] 2017 [cited 2017 Apr 24];65, Suppl S1:93-4. Available from: http://www.neurologyindia.com/text.asp?2017/65/7/93/201665


Sir,

Rhabdomyolysis (RM) is a clinical syndrome that results from fulminant damage of the skeletal muscles and the release of intracellular muscle components into the bloodstream. There are many reports of status epilepticus-related RM, whereas RM induced by a single-episode seizure has been rarely reported.

A 42-year-old man presented to the emergency room because of an episode of generalized tonic–clonic seizure lasting for approximately 5 minutes without further seizure attacks. He complained of having pain in his limbs and waist after the epileptic seizure. Laboratory evaluation revealed that the serum creatine kinase (CK) had increased to 7617 U/L and the serum creatinine had increased to 226 μmol/L. No typical epileptic discharge was found on the electroencephalographic (EEG) examination [Figure 1]a and [Figure 1]b; brain magnetic resonance imaging revealed possible hippocampal sclerosis [Figure 2]a, [Figure 2]b,[Figure 2]c. He was managed with optimum rehydration and decreased glutathione to treat the renal damage. The CK level and creatinine were found to be normal 14 days later. No further seizures occurred and CK levels were normal during the 6-month follow up.
Figure 1: Electroencephalogram examination of the patient 24 hours after the seizure attack. No typical epileptic discharge was found in the EEG examination during the state of waking (a) and sleep (b)

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Figure 2: Brain magnetic resonance imaging of the patient 48 hours after the seizure attack. Axial T1-weighted image (a) and T2-weighted image (b) showed hypointense and slightly hyperintense signal in bilateral hippocampal regions, respectively. (c) Coronal fluid-attenuated inversion-recovery image showed hyperintense signal in the area of bilateral hippocampi

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The typical clinical manifestations of RM are myalgia, muscle weakness, and myoglobinuria. It is a diverse etiology that can be categorized into four mechanisms, namely, hypoxic, physical, chemical, and biological; the chemical causes account for the majority of cases till date. Seizures are an unusual cause of RM. They are classified as belonging to the category of 'internal factors' that result from injury due to involuntarily muscle overuse. One study that included 475 hospitalized RM patients found that seizures occurred in 32 (approximately 7%) patients, and was considered to subsequently result in RM.[1] However, RM is more common in status epilepticus when compared with those having a single seizure attack. The diagnosis of RM is mainly based on serum CK elevation; most researchers consider serum CK elevation of >5 times the normal as being sufficient evidence for making a diagnosis.[2] In our patient, the CK level was increased to more than 5 times the upper limit of the normal range. As no further seizure attacks occurred and no other causative factors were found, he was finally diagnosed as having seizure-induced RM. Thus, we report a special and rare case of RM that was caused by a single-episode of seizure.

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 » References Top

1.
Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: An evaluation of 475 hospitalized patients. Medicine 2005;84:377-85.  Back to cited text no. 1
    
2.
Sauret JM, Marinides G, Wang GK. Rhabdomyolysis. Am Fam Physician 2002;65:907-12.  Back to cited text no. 2
    


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