ORIGINAL ARTICLE
Serum Ischemia-Modified Albumin Levels in Children With Epileptic Seizures Celebi Kocaoglu, MD,* Huseyin Caksen, MD,Þ Mehmet Emre Atabek, MD,þ Huseyin Kurku, MD,§ and Sukru Arslan, MD||
Objectives: The aim of the present study was to determine the level of ischemia-modified albumin (IMA) in children with epileptic seizures (ESs) and its relation with the seizure duration. Methods: The study was performed with 88 children as a prospective case-control study. Blood samples for IMA were obtained from 57 patients (mean age [SD], 50.86 [51.15] months) within 3 hours after ES and 31 healthy control subjects (mean age [SD], 53.13 [40.87] months). Ischemia-modified albumin was measured by the albumin cobalt binding test. Results: Although the mean (SD) of serum IMA level of the patients with seizure was 13.66 (13.16) U/mL, the mean (SD) of serum IMA level for the control group was 3.73 (1.93) U/mL. Ischemia-modified albumin levels were significantly higher in patients with seizure, compared with that in the control group (P G 0.01). When patients were grouped in itself according to the duration of ESs, the levels of IMA were detected to be increased in patients as the duration of seizures was lengthened. Conclusions: Increased IMA levels after seizures suggest that IMA assay during seizure may be useful for predicting the diagnosis and severity of convulsion. Key Words: ischemia-modified albumin, epileptic seizure, differential diagnosis, childhood (Pediatr Emer Care 2014;30: 394Y396)
H
uman serum albumin consists of 585 amino acids. The first 3 amino acids in the N-terminus, Asp-Ala-His, are specific binding sites for transition metals such as cobalt (II), copper (II), and nickel (II) and the most susceptible regions for degradation, compared with other regions of albumin.1 Ischemia-modified albumin (IMA) is approximately 1% to 2% of the total albumin concentration and increases to 6% to 8% in patients experiencing ischemia. Various studies have shown that the IMA level increases within minutes after the onset of ischemia, remains elevated for 6 to 12 hours, and returns to normal within 24 hours.2,3 During acute ischemic conditions, the metal-binding capacity of albumin for transition metals such as copper, nickel, and cobalt is reduced, generating a metabolic variant of the protein, commonly known as IMA.4 However, the IMA level may increase in conditions of noncardiac ischemia such as skeletal muscle, cerebral, pulmonary, and gastrointestinal ischemia and in diseases, potent producers of free radicals.5Y9
The main mechanism of the production of IMA during ischemic events is proposed to be related to the oxidative stress caused by free radicals during ischemia and/or reperfusion.10,11 During an acute ischemic event, structural changes occur in the amino terminus of albumin, rapidly reducing its capacity to bind transition metal ions and generate a metabolic variant of the albumin referred as IMA.11 The aim of this study was to determine the changes of IMA levels in epileptic seizures (ESs) and its relation with the seizure duration. In this study, we investigated the serum IMA levels in children with ES. To the best of our knowledge, no study has been performed about IMA levels in children with ES.
METHODS Sixty-five consecutive patients with ES, admitted to the department of pediatric emergency of Konya Education and Research Hospital in Turkey from July 2011 to June 2012, were enrolled into this prospective case-controlled study. Patients with documented or clinical evidence of ES were included into the study. Patients were excluded from the study if they had other ischemic diseases, such as acute coronary syndrome, pulmonary embolism, or if they had diabetes mellitus, end-stage renal disease, acute or chronic lung disease, congenital heart disease, chronic liver disease, A-thalassemia major, soft tissue sarcomas and neuroblastoma, ovarian torsion, obesity, and abnormal serum albumin level (albumin level, G3.0 and 95.5 mg/dL). The exclusion criteria for controls were the same as those for patients. Patients were further excluded if the age levels were over 16 or if they refused to participate in the study. Eight patients were excluded on the basis of predefined criteria as follows: diabetes (n = 1), congenital heart disease (n = 1), obesity (n = 2), acute or chronic lung disease (n = 2), and low albumin levels (n = 1). Finally, 57 patients with ES and 31 healthy children constituted all participants in our study. The study was approved by the ethics committee of Selcuk University Faculty of Medicine. Written informed consents were obtained from the parents of all participants. Patients with ES were divided into 3 categories based on the duration of seizures (group 1, e3 minutes; group 2, 4Y14 minutes, and group 3, Q15 minutes). On admission, demographic characteristics, type, and duration of seizures were recorded in all patients. Blood samples for IMA determination were taken within 3 hours of seizure onset.12
Laboratory Analysis From the *Department of Pediatrics, Konya Education and Research Hospital; Departments of †Pediatric Neurology and ‡Pediatric Endocrinology, Faculty of Medicine, Necmeddin Erbakan University; Departments of §Biochemistry and ||Pediatric Nephrology, Konya Education and Research Hospital, Konya, Turkey. Disclosure: The authors declare no conflict of interest. Reprints: Celebi Kocaoglu, MD, Department of Pediatrics, Konya Training and Research Hospital, Meram Yeni Yol Street, 42040 Meram, Konya, Turkey (e
Serum Ischemia-Modified Albumin Levels in Children With Epileptic Seizures Celebi Kocaoglu, MD,* Huseyin Caksen, MD,Þ Mehmet Emre Atabek, MD,þ Huseyin Kurku, MD,§ and Sukru Arslan, MD||
Objectives: The aim of the present study was to determine the level of ischemia-modified albumin (IMA) in children with epileptic seizures (ESs) and its relation with the seizure duration. Methods: The study was performed with 88 children as a prospective case-control study. Blood samples for IMA were obtained from 57 patients (mean age [SD], 50.86 [51.15] months) within 3 hours after ES and 31 healthy control subjects (mean age [SD], 53.13 [40.87] months). Ischemia-modified albumin was measured by the albumin cobalt binding test. Results: Although the mean (SD) of serum IMA level of the patients with seizure was 13.66 (13.16) U/mL, the mean (SD) of serum IMA level for the control group was 3.73 (1.93) U/mL. Ischemia-modified albumin levels were significantly higher in patients with seizure, compared with that in the control group (P G 0.01). When patients were grouped in itself according to the duration of ESs, the levels of IMA were detected to be increased in patients as the duration of seizures was lengthened. Conclusions: Increased IMA levels after seizures suggest that IMA assay during seizure may be useful for predicting the diagnosis and severity of convulsion. Key Words: ischemia-modified albumin, epileptic seizure, differential diagnosis, childhood (Pediatr Emer Care 2014;30: 394Y396)
H
uman serum albumin consists of 585 amino acids. The first 3 amino acids in the N-terminus, Asp-Ala-His, are specific binding sites for transition metals such as cobalt (II), copper (II), and nickel (II) and the most susceptible regions for degradation, compared with other regions of albumin.1 Ischemia-modified albumin (IMA) is approximately 1% to 2% of the total albumin concentration and increases to 6% to 8% in patients experiencing ischemia. Various studies have shown that the IMA level increases within minutes after the onset of ischemia, remains elevated for 6 to 12 hours, and returns to normal within 24 hours.2,3 During acute ischemic conditions, the metal-binding capacity of albumin for transition metals such as copper, nickel, and cobalt is reduced, generating a metabolic variant of the protein, commonly known as IMA.4 However, the IMA level may increase in conditions of noncardiac ischemia such as skeletal muscle, cerebral, pulmonary, and gastrointestinal ischemia and in diseases, potent producers of free radicals.5Y9
The main mechanism of the production of IMA during ischemic events is proposed to be related to the oxidative stress caused by free radicals during ischemia and/or reperfusion.10,11 During an acute ischemic event, structural changes occur in the amino terminus of albumin, rapidly reducing its capacity to bind transition metal ions and generate a metabolic variant of the albumin referred as IMA.11 The aim of this study was to determine the changes of IMA levels in epileptic seizures (ESs) and its relation with the seizure duration. In this study, we investigated the serum IMA levels in children with ES. To the best of our knowledge, no study has been performed about IMA levels in children with ES.
METHODS Sixty-five consecutive patients with ES, admitted to the department of pediatric emergency of Konya Education and Research Hospital in Turkey from July 2011 to June 2012, were enrolled into this prospective case-controlled study. Patients with documented or clinical evidence of ES were included into the study. Patients were excluded from the study if they had other ischemic diseases, such as acute coronary syndrome, pulmonary embolism, or if they had diabetes mellitus, end-stage renal disease, acute or chronic lung disease, congenital heart disease, chronic liver disease, A-thalassemia major, soft tissue sarcomas and neuroblastoma, ovarian torsion, obesity, and abnormal serum albumin level (albumin level, G3.0 and 95.5 mg/dL). The exclusion criteria for controls were the same as those for patients. Patients were further excluded if the age levels were over 16 or if they refused to participate in the study. Eight patients were excluded on the basis of predefined criteria as follows: diabetes (n = 1), congenital heart disease (n = 1), obesity (n = 2), acute or chronic lung disease (n = 2), and low albumin levels (n = 1). Finally, 57 patients with ES and 31 healthy children constituted all participants in our study. The study was approved by the ethics committee of Selcuk University Faculty of Medicine. Written informed consents were obtained from the parents of all participants. Patients with ES were divided into 3 categories based on the duration of seizures (group 1, e3 minutes; group 2, 4Y14 minutes, and group 3, Q15 minutes). On admission, demographic characteristics, type, and duration of seizures were recorded in all patients. Blood samples for IMA determination were taken within 3 hours of seizure onset.12
Laboratory Analysis From the *Department of Pediatrics, Konya Education and Research Hospital; Departments of †Pediatric Neurology and ‡Pediatric Endocrinology, Faculty of Medicine, Necmeddin Erbakan University; Departments of §Biochemistry and ||Pediatric Nephrology, Konya Education and Research Hospital, Konya, Turkey. Disclosure: The authors declare no conflict of interest. Reprints: Celebi Kocaoglu, MD, Department of Pediatrics, Konya Training and Research Hospital, Meram Yeni Yol Street, 42040 Meram, Konya, Turkey (e
