Evaluation of zinc and copper levels measured during epileptic seizure

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