Concentrações de cloro, sódio, potássio e fósforo no líquido cefalorraqueano durante crises convulsivas

Spina-França, A.; Salvia, Waldemar; Assis, Luís M. de; Jorge, Francisco B. de; Marlet, J. M.; Zaidan, Milton

doi:10.1590/S0004-282X1963000200004

Resumos

Estudo do comportamento das concentrações de cloro, sódio, potássio e fósforo inorgânico no LCR de 33 pacientes na vigência de crises convulsivas e de 17 pacientes epilépticos na interfase de crises convulsivas. Os resultados obtidos foram estudados em comparação aos valôres normais anteriormente relatados. Não foram encontradas modificações quanto às taxas de íons estudados no LCR dos pacientes epilépticos examinados no período intercrítico. Foram verificadas alterações das taxas de íons estudados no LCR entre os pacientes estudados na vigência de crise convulsiva. As alterações encontradas se caracterizavam por aumento das taxas de potássio e de fósforo inorgânico. Os aumentos encontrados foram estatisticamente significantes. A taxa de sódio no LCR dos pacientes cuja crise convulsiva não se associava a outras manifestações de doença se apresentava, em média, aumentada. Diminuição das taxas médias de sódio e de cloro foi constatada entre os pacientes cuja crise convulsiva ocorreu durante reidratação. Os resultados foram discutidos em relação a dados da literatura quanto às modificações do metabolismo iônico envolvidas nos fenômenos de despo- larização de membrana, que ocorrem na crise convulsiva. Os aumentos verificados para as concentrações de potássio e de fósforo inorgânico no LCR durante a crise convulsiva confirmam os dados quanto à passagem dêsses ions do espaço intracelular para o extracelular nessas condições, já registrados através de estudos feitos no sangue e em amostras de cérebro de epilépticos.

The concentrations of Cl, Na, K and inorganic P were determined in CSF samples of 50 patients with epilepsy. In 33 patients the sample studied was collected at the occasion of a convulsive seizure (group I). In 17 patients it was collected in the intermediate period between seizures (group II). The patients of group I were children. They were grouped according to conditions associated to the convulsive seizure. In 9, there were no other manifestation of disease (sub-group Ia). In 12, the seizure was associated to hyperthermy (sub-group lb) and in 12 it occurred during rehydration therapy (sub-group Ic). The results were compared statistically to those obtained for a series of 25 non epileptic patients taken as control (group III). The results obtained for the latter fall in the normal range and were reported previously. Results obtained for the patients of the group II did not differ from those found in the control group. The concentrations of K and inorganic P were found to be increased in group I. Their mean differ significantly of those found for control group. There occurred a positive correlation between the concentrations of K and P in group I. The value of the correlation was significant. The findings regarding to the concentration of Na show shiftings that were not uniform. Their mean value was elevated in the sub-group Ia, normal in the sub-group Ib and low in the sub-group Ic. The mean value of the Cl concentration was low in the sub-group Ic. It was normal in the other two sub-groups. Data concerning to the changes in the concentrations of K and inorganic P in the CSF during convulsive seizures were discussed. Bioelectric changes of the cellular membrane during seizures are reported in the literature. They induce the passage of these components through the cellular membrane to the extracellular space thus resulting the elevation of their concentration in this space. The results presented make it possible to evaluate the extension of such changes in the fluid of the extravascular space. The latter is represented in the case by the CSF. The exchange of intracellular K and inorganic P to the extracellular space is accompanied by exchange of Na in the opposite direction. The Na concentration is referred to elevated in the intracellular space in these circumstances. The results reported suggest that Na is not provided by CSF only, for this exchange. Other compartments of the extracellular space and/or of the intracellular space may be more directly involved. This is suggested because the concentrations of Na in the CSF did not show uniform changes in the three sub-groups of patients with seizures that were considered. General changes in the extracellular fluid composition might explain the differences in the concentration of Na which were reported. The concentrations of Na and Cl found in the CSF of patients with convulsion during rehydration therapy are elucidative in this way. They were found to be low, suggesting an excess in the water uptake.

A. Spina-França ^I; Waldemar Salvia ^II; Luís M. de Assis ^I; Francisco B. de Jorge ^I; J. M. Marlet^III; Milton Zaidan^II

^IAssistente; Trabalho da Clínica Neurológica (Prof. A. Tolosa), da Clinica Médica (Prof. A. B. Ulhoa Cintra) e da Clínica Pediátrica (Prof. Pedro de Alcântara M. Machado) da Faculdade de Med. da Univ. de São Paulo

^IIMédico plantonista de Pronto Socorro; Trabalho da Clínica Neurológica (Prof. A. Tolosa), da Clinica Médica (Prof. A. B. Ulhoa Cintra) e da Clínica Pediátrica (Prof. Pedro de Alcântara M. Machado) da Faculdade de Med. da Univ. de São Paulo

^IIIAcadêmico estagiário; Trabalho da Clínica Neurológica (Prof. A. Tolosa), da Clinica Médica (Prof. A. B. Ulhoa Cintra) e da Clínica Pediátrica (Prof. Pedro de Alcântara M. Machado) da Faculdade de Med. da Univ. de São Paulo

RESUMO

Estudo do comportamento das concentrações de cloro, sódio, potássio e fósforo inorgânico no LCR de 33 pacientes na vigência de crises convulsivas e de 17 pacientes epilépticos na interfase de crises convulsivas. Os resultados obtidos foram estudados em comparação aos valôres normais anteriormente relatados.

Não foram encontradas modificações quanto às taxas de íons estudados no LCR dos pacientes epilépticos examinados no período intercrítico.

Foram verificadas alterações das taxas de íons estudados no LCR entre os pacientes estudados na vigência de crise convulsiva. As alterações encontradas se caracterizavam por aumento das taxas de potássio e de fósforo inorgânico. Os aumentos encontrados foram estatisticamente significantes. A taxa de sódio no LCR dos pacientes cuja crise convulsiva não se associava a outras manifestações de doença se apresentava, em média, aumentada. Diminuição das taxas médias de sódio e de cloro foi constatada entre os pacientes cuja crise convulsiva ocorreu durante reidratação.

Os resultados foram discutidos em relação a dados da literatura quanto às modificações do metabolismo iônico envolvidas nos fenômenos de despo- larização de membrana, que ocorrem na crise convulsiva. Os aumentos verificados para as concentrações de potássio e de fósforo inorgânico no LCR durante a crise convulsiva confirmam os dados quanto à passagem dêsses ions do espaço intracelular para o extracelular nessas condições, já registrados através de estudos feitos no sangue e em amostras de cérebro de epilépticos.

SUMMARY

The concentrations of Cl, Na, K and inorganic P were determined in CSF samples of 50 patients with epilepsy. In 33 patients the sample studied was collected at the occasion of a convulsive seizure (group I). In 17 patients it was collected in the intermediate period between seizures (group II).

The patients of group I were children. They were grouped according to conditions associated to the convulsive seizure. In 9, there were no other manifestation of disease (sub-group Ia). In 12, the seizure was associated to hyperthermy (sub-group lb) and in 12 it occurred during rehydration therapy (sub-group Ic).

The results were compared statistically to those obtained for a series of 25 non epileptic patients taken as control (group III). The results obtained for the latter fall in the normal range and were reported previously.

Results obtained for the patients of the group II did not differ from those found in the control group.

The concentrations of K and inorganic P were found to be increased in group I. Their mean differ significantly of those found for control group. There occurred a positive correlation between the concentrations of K and P in group I. The value of the correlation was significant.

The findings regarding to the concentration of Na show shiftings that were not uniform. Their mean value was elevated in the sub-group Ia, normal in the sub-group Ib and low in the sub-group Ic. The mean value of the Cl concentration was low in the sub-group Ic. It was normal in the other two sub-groups.

Data concerning to the changes in the concentrations of K and inorganic P in the CSF during convulsive seizures were discussed. Bioelectric changes of the cellular membrane during seizures are reported in the literature. They induce the passage of these components through the cellular membrane to the extracellular space thus resulting the elevation of their concentration in this space. The results presented make it possible to evaluate the extension of such changes in the fluid of the extravascular space. The latter is represented in the case by the CSF.

The exchange of intracellular K and inorganic P to the extracellular space is accompanied by exchange of Na in the opposite direction. The Na concentration is referred to elevated in the intracellular space in these circumstances. The results reported suggest that Na is not provided by CSF only, for this exchange. Other compartments of the extracellular space and/or of the intracellular space may be more directly involved. This is suggested because the concentrations of Na in the CSF did not show uniform changes in the three sub-groups of patients with seizures that were considered. General changes in the extracellular fluid composition might explain the differences in the concentration of Na which were reported. The concentrations of Na and Cl found in the CSF of patients with convulsion during rehydration therapy are elucidative in this way. They were found to be low, suggesting an excess in the water uptake.

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Clínica Neurológica - Faculdade de Medicina da USP - Caixa Postal 3461 - São Paulo, SP - Brasil

Agradecemos aos técnicos Sr. Antonio Germano da Silva e Sra. Lilia A. de Vilhena Nunes a colaboração prestada nas análises químicas.

1. COILRAUT, R.; JEANNETON, C. - Epilepsie et Métabolisme Céllulaire. Orientations Thérapeutiques. Libr. Maloine, Paris, 1959.
2. COLFER, H. F.; ESSEX, H. E. - The distribution of total electrolyte, potassium and sodium, in the cerebral cortex in relation to experimental convultions. Am. J. Physiol., 150:27-36, 1947.
3. ILWAIN, H. Mc - Biochemistry and the Central Nervous System. J. & A. Churchill Ltd., London, 1955, pág. 233.
4. KLEIN, J. R.; OLSEN, N. S. - Effect of convulsive activity upon the concentration of brain glucose, glycogen, lactate and phosphats. J. Biol. Chem., 167:747-756, 1947.
5. KOLMER, J. A.; SPAULDING, E. H.; ROBINSON, H. W. - Approved Laboratory Technic, 5ª ed., Appleton, Century, Crofts Inc., New York, 1951.
6. MEYER, J. S.; GOTOH, F.; TAZAKI, Y. - Inhibitory action of carbon dioxid and acetazoleamide In seizure activity. EEG and CI. Neuro-physiol., 5:762-775, 1961.
7. MILLICHAP, J. G. - Studies on febrile seizures; the balance of water and electrolytes. Neurology 10:312-321, 1960.
8. MILLICHAP, J. G.; BALTER, M.; HERNANDEZ, P. - Development of susceptibility to seizures in young animals: brain water, electrolyte and acid-base metabolism. Proc. Soc. Exper. Biol. Med., 99:6-11, 1960.
9. MILLICHAP, J. G.; MADSEN, J. A.; ALEDORT, L. M. - Studies in febrile seizures: clinical and electroencephalographic study in un-selected patients. Neurology 10:643-653, 1960.
10. MUSSA, G. C. - Valutazione del liquido extracellulare nel lattante distrofico. Minerva Ped., 13:427-431, 1961.
11. POCH, G. F. - Las modificaciones electroencefalográficas y electrolíticas determinadas por la inyección endovenosa de acetazolamida en enfermos con pequeño mal. Rev. Neurol, de Buenos Aires 19:31-35, 1961.
12. SPINA-FRANÇA, A.; De JORGE, F. B. - Concentrações de cloro, sódio, potássio e fósforo no líquido cefalorraqueano normal. Arq. Neuro-Psiquiat., 21:96-104, 1963.
13. TOWER, D. B. - Nature and extent of the biochemical lesion in human epileptogenic cerebral cortex. Neurology 5:113-130, 1955.
14. TOWER, D. B. - Neurochemistry of Epilepsy. Illinois, Springfield, Charles C. Thomas, 1960.
15. VAN HARREVELD, A.; ACHADÉ, J. P. - Changes in the electrical conductivity of cerebral cortex during seizure activity. Exp. Neurol., 5:383-400, 1962.
16. WOODBURY, D. M. - Redistribution of electrolytes (K, Na, P) following electroshock convulsions in rat. Am. J. Physiol., 155:479, 1948.
17. WOODBURY, D. M.; KOCH, A.; VERNADAKIS, A. - Relation between excitability and metabolism in brain as elucidated by anticonvulsant drugs. Neurology 8 (supl. 1):113-116, 1958.

Concentrações de cloro, sódio, potássio e fósforo no líquido cefalorraqueano durante crises convulsivas

Concentrations of Cl, Na, K and inorganic P in the cerebrospinal fluid during convulsive seizures.

Datas de Publicação

Publicação nesta coleção
21 Ago 2013
Data do Fascículo
Jun 1963

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. COILRAUT, R.; JEANNETON, C. - Epilepsie et Métabolisme Céllulaire. Orientations Thérapeutiques. Libr. Maloine, Paris, 1959.

[2] 2. COLFER, H. F.; ESSEX, H. E. - The distribution of total electrolyte, potassium and sodium, in the cerebral cortex in relation to experimental convultions. Am. J. Physiol., 150:27-36, 1947.

[3] 3. ILWAIN, H. Mc - Biochemistry and the Central Nervous System. J. & A. Churchill Ltd., London, 1955, pág. 233.

[4] 4. KLEIN, J. R.; OLSEN, N. S. - Effect of convulsive activity upon the concentration of brain glucose, glycogen, lactate and phosphats. J. Biol. Chem., 167:747-756, 1947.

[5] 5. KOLMER, J. A.; SPAULDING, E. H.; ROBINSON, H. W. - Approved Laboratory Technic, 5ª ed., Appleton, Century, Crofts Inc., New York, 1951.

[6] 6. MEYER, J. S.; GOTOH, F.; TAZAKI, Y. - Inhibitory action of carbon dioxid and acetazoleamide In seizure activity. EEG and CI. Neuro-physiol., 5:762-775, 1961.

[7] 7. MILLICHAP, J. G. - Studies on febrile seizures; the balance of water and electrolytes. Neurology 10:312-321, 1960.

[8] 8. MILLICHAP, J. G.; BALTER, M.; HERNANDEZ, P. - Development of susceptibility to seizures in young animals: brain water, electrolyte and acid-base metabolism. Proc. Soc. Exper. Biol. Med., 99:6-11, 1960.

[9] 9. MILLICHAP, J. G.; MADSEN, J. A.; ALEDORT, L. M. - Studies in febrile seizures: clinical and electroencephalographic study in un-selected patients. Neurology 10:643-653, 1960.

[10] 10. MUSSA, G. C. - Valutazione del liquido extracellulare nel lattante distrofico. Minerva Ped., 13:427-431, 1961.

[11] 11. POCH, G. F. - Las modificaciones electroencefalográficas y electrolíticas determinadas por la inyección endovenosa de acetazolamida en enfermos con pequeño mal. Rev. Neurol, de Buenos Aires 19:31-35, 1961.

[12] 12. SPINA-FRANÇA, A.; De JORGE, F. B. - Concentrações de cloro, sódio, potássio e fósforo no líquido cefalorraqueano normal. Arq. Neuro-Psiquiat., 21:96-104, 1963.

[13] 13. TOWER, D. B. - Nature and extent of the biochemical lesion in human epileptogenic cerebral cortex. Neurology 5:113-130, 1955.

[14] 14. TOWER, D. B. - Neurochemistry of Epilepsy. Illinois, Springfield, Charles C. Thomas, 1960.

[15] 15. VAN HARREVELD, A.; ACHADÉ, J. P. - Changes in the electrical conductivity of cerebral cortex during seizure activity. Exp. Neurol., 5:383-400, 1962.

[16] 16. WOODBURY, D. M. - Redistribution of electrolytes (K, Na, P) following electroshock convulsions in rat. Am. J. Physiol., 155:479, 1948.

[17] 17. WOODBURY, D. M.; KOCH, A.; VERNADAKIS, A. - Relation between excitability and metabolism in brain as elucidated by anticonvulsant drugs. Neurology 8 (supl. 1):113-116, 1958.