Post-ictal leucocytosis

An early Sunday morning call from the emergency unit medical officer working at a nearby hospital concerns the issue of a white cell count of 19 (81% polys & 11% lymphs) and a CRP of 14 in a patient, known to me, following a GTCS. The patient has flu-like symptoms. Should he admit the patient because of the elevated white cell count? This begs the question about the magnitude of the increase of the white cell count after seizures. Fortunately, there is some literature on this to guide decision-making.

Bottom line? The white cell count is elevated in about one out of three people following a generalized tonic-clonic seizure, the duration of a generalized tonic-clonic seizure matters, the timing of the blood collection is important (as it is with prolactin levels) and the levels may be as high as 20 iU; the mean compared to baseline was approximately 5 iU. Hence, in the absence of more definitive evidence to distinguish epileptic from other events, the white cell count and the prolactin may be useful in the emergency unit setting. Try to ensure that your emergency unit staff get into the habit of videoing events for you. The more evidence that you have, the better. As for the patient, he was awake and back to baseline; suggested discharge from the EU, to follow up with his general practitioner as needed for his URTI.

PS: I often see patients admitted via the emergency unit who have an elevated white cell count following a tonic-clonic seizure(s). Generally, these are not very high (10-14 is common)

There are some limitations to the study. Blood levels were taken within the first 75 minutes after a seizure. hence, the window periods may have been missed in some. In the methods they say that the studied 340 events in 89 patients. This is not ideal, as it assumes that the 340 events are independent of one another, but these clearly may not be since an average of about four samples were obtained per patient.

 PS: animal models demonstrate that the leukocytosis consists primarily of polymorphonuclear leucocytes. The following study in humans demonstrated the same:

Elevated body temperature and leukocyte count are associated with elevated creatine kinase after seizures - PubMed