Background: Tonic-clonic seizures (TCS) have a lot of metabolic processes inside the body, leading to metabolic responses in all systems, including the brain, muscles, liver, kidneys, and blood. This study aimed to differentiate if tonic-clonic seizures were of epileptogenic or non-epileptogenic origin and examine alternative biomarkers for accurate differentiation.

Methods: Our case-control study was performed in the Pediatrics department at Zagazig University Hospital. A total of 120 individuals were divided into two groups. The first group consisted of children aged six months to fifteen years experiencing tonic-clonic seizures, while the second group included matched healthy children as controls. Blood markers, including lactate, ammonia, and creatine kinase (CK), were analyzed to assess their effectiveness in differentiating between the two groups.

Results: The study revealed a significant elevation in lactate levels among cases compared to the control children (P < 0.001). Ammonia levels were also significantly higher among the patients than controls (P < 0.001). Furthermore, the study found a positive correlation between the duration of tonic-clonic seizures and lactate levels in the blood (P=0.016), highlighting lactate's potential utility as an indicator of seizure severity.

Conclusions: The study underscores the significance of monitoring lactate and ammonia levels during TCS episodes as valuable indicators of seizure severity and metabolic disturbances.