Can a seizure cause neutrophilia (elevated neutrophil count) and what is the appropriate treatment?

From the Guidelines

Seizures can indeed cause neutrophilia, which is an elevated neutrophil count in the blood, due to the body's stress response during a seizure, which triggers the release of catecholamines and cortisol, leading to demargination of neutrophils from blood vessel walls into circulation. This occurs as a result of the body's natural response to stress, including seizures, which can lead to changes in white blood cell counts, including an increase in neutrophils 1. The neutrophilia following a seizure is typically transient and resolves on its own without specific treatment for the elevated neutrophil count.

Key Points to Consider

• The appropriate treatment should focus on managing the underlying seizure disorder rather than the neutrophilia itself.
• This includes antiepileptic medications such as levetiracetam (500-1500 mg twice daily), lamotrigine (25-200 mg twice daily), or valproic acid (10-15 mg/kg/day in divided doses) depending on the seizure type and patient characteristics.
• For acute seizure management, benzodiazepines like lorazepam (2-4 mg IV) or diazepam (5-10 mg IV) may be used.
• Routine monitoring of neutrophil counts is not necessary unless there are other clinical concerns or the patient is on medications that may affect white blood cell counts.
• The neutrophilia should normalize within 24-48 hours after the seizure episode as the stress response subsides, as supported by studies on the management of seizures and their effects on white blood cell counts 1.

Management of Seizures and Neutrophilia

• The management of seizures should prioritize the use of antiepileptic medications and acute seizure management with benzodiazepines.
• The focus should be on managing the underlying seizure disorder, rather than the neutrophilia itself, which is typically transient and self-resolving.
• It is essential to consider the patient's overall clinical condition and medical history when managing seizures and neutrophilia, including any potential interactions with other medications or underlying medical conditions 1.

From the Research

Seizure-Induced Neutrophilia

• A seizure can cause an increase in neutrophil count, also known as neutrophilia, as evidenced by studies that have shown a significant increase in white blood cell (WBC) count, including neutrophils, after a seizure 2, 3, 4.
• The increase in neutrophil count is thought to be a result of the body's inflammatory response to the seizure, which can lead to the release of pro-inflammatory cytokines and other mediators that stimulate the production of neutrophils 2, 3.
• The severity and duration of the seizure can also impact the degree of neutrophilia, with longer and more severe seizures tend to cause a greater increase in neutrophil count 4.

Treatment of Seizure-Induced Neutrophilia

• The treatment of seizure-induced neutrophilia is generally focused on managing the underlying seizure disorder, rather than specifically targeting the elevated neutrophil count 5.
• Antiepileptic drugs (AEDs) are commonly used to treat seizures, and while they can cause changes in WBC count, including leukopenia, they are not typically associated with neutrophilia 5.
• In some cases, the use of AEDs may need to be adjusted or discontinued if they are found to be contributing to changes in WBC count, including neutrophilia 5.

Distinguishing Seizure-Induced Neutrophilia from Infection

• It can be challenging to distinguish seizure-induced neutrophilia from an infection, as both can cause an increase in WBC count and other inflammatory markers 3.
• However, studies have shown that the increase in body temperature and C-reactive protein (CRP) levels tend to be milder in patients with seizure-induced neutrophilia compared to those with an infection 3.
• Additionally, the presence of other symptoms, such as fever, chills, and localized signs of infection, can help to distinguish an infection from seizure-induced neutrophilia 3.