Status epilepticus increases CSF levels of neuron-specific enolase and alters the blood-brain barrier

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Abstract
Neuron-specific enolase (NSE) is a sensitive marker of brain damage in stroke, global ischemia, and coma. Serum NSE is also correlated with the duration and outcome of status epilepticus (SE). CSF-NSE levels have not been previously reported in SE. We report the CSF concentrations of NSE in 11 patients with cryptogenic/remote symptomatic SE. CSF obtained within 24 hours of SE showed increased concentrations of NSE in 9 of 11 patients. The mean CSF-NSE for the group was elevated compared with the levels for normal control subjects (30.8 ± 18.33 versus 10.76 ± 3.08 ng/mL;p = 0.002). Further, CSF-NSE levels were elevated compared with simultaneous serum levels in the same group of patients (p = 0.01). In addition, the CSF/serum albumin ratio (QAlb), a measure of the integrity of the blood-brain barrier, was increased in SE patients compared with control individuals (33.4 versus 4.79 × 10-3;p = 0.0001). An increase of QAlb correlated with CSF-NSE(rs = 0.66, p = 0.04) and serum NSE levels(rs = 0.83, p = 0.004). CSF-NSE is a promising in vivo marker for brain injury after SE.