From the Guidelines
Seizures can cause a temporary increase in White Blood Cell (WBC) count, known as post-ictal leukocytosis, due to the body's stress response and catecholamine release during seizure activity. This elevation in WBC count is usually mild and resolves on its own within 24-48 hours after the seizure. When evaluating a patient with seizures and an elevated WBC count, it is essential to consider the timing of the blood draw relative to the seizure, as well as other clinical signs of infection, to determine whether the elevation represents a significant finding requiring further investigation or treatment.
Some key points to consider when evaluating elevated WBC counts in seizure patients include:
- The normal WBC count ranges from approximately 4,500 to 11,000 cells per microliter, with values above this suggesting an inflammatory response 1.
- Post-ictal leukocytosis is a physiological response to the physical stress and catecholamine release during seizure activity.
- Certain anti-epileptic medications, such as carbamazepine, can occasionally cause leukocytosis as a side effect, as noted in the context of clozapine use 1.
- The patient's medication profile and other clinical signs of infection should be taken into account when determining whether the elevation in WBC count requires further investigation or treatment.
In the context of clozapine use, which is associated with a risk of seizures and agranulocytosis, regular monitoring of WBC counts is crucial to prevent and manage potential adverse effects 1. However, in the general context of seizures, the primary concern is determining whether the elevated WBC count is a result of the seizure itself or an underlying infection or inflammation that may be contributing to the seizures.
From the Research
Seizures and WBC Count
- Seizures can produce systemic changes, including elevated white blood cell (WBC) count, which may raise concern for potential infection 2.
- Studies have shown that seizures can induce an increase in WBC count, with one study finding that 56.3% of patients experiencing seizures had an inflammation-like response, including elevated WBC count 2.
- The type of seizure may also play a role in the elevation of WBC count, with generalized seizures being associated with a significant increase in WBC count 3.
- The length of the seizure and the time lapse between the seizure onset and blood draw may also be correlated with the increase in WBC count, with longer seizures and quicker blood draws resulting in higher WBC counts 3.
Mechanisms and Pathophysiology
- The exact mechanisms of seizure-induced elevation of WBC count are not fully understood, but may be related to the body's stress response to the seizure 2, 3.
- Some studies have suggested that certain antiepileptic drugs, such as carbamazepine, may also play a role in the elevation of WBC count 4, 5.
- However, other studies have found that the elevation of WBC count is likely a transient response to the seizure itself, rather than a result of the antiepileptic medication 3.
Clinical Significance
- The elevation of WBC count in patients experiencing seizures can make it challenging to distinguish between seizure-induced inflammation and infection 2.
- Clinicians should be aware of the potential for seizure-induced elevation of WBC count and consider this when interpreting laboratory results and making diagnostic decisions 2, 3.
- Further research is needed to fully understand the mechanisms and clinical significance of seizure-induced elevation of WBC count 2, 3.