A 65-year-old man was brought to our emergency department after a seizure. The patient was lethargic and confused when he arrived. The medication he had been prescribed, Dilantin (Parke-Davis, Morris Plains, New Jersey), was not present in his blood. Results of physical examination of the patient's abdomen were normal. His serum amylase level was 9.19 µkat/L (normal, 0.57 to 2.03 µkat/L). This elevation prompted physicians to do computed tomography of the abdomen. No abnormality was detected in the pancreas. The patient was admitted to the hospital for observation. His mental status became normal, he ate, and he had no abdominal pain. His serum amylase level the next day was 3.78 µkat/L; the patient felt well and was discharged.

We reviewed the charts of patients who were known to have had a generalized tonic-clonic seizure shortly before admission or during their hospital stay. We excluded those with evidence of pancreatitis, renal failure, or alcohol abuse. All charts that were reviewed had to have recorded an amylase level. Forty-one charts were reviewed, and 41 were randomly chosen to serve as controls. The serum amylase level was found to be elevated in 29 of the 41 (71%) patients who had had generalized tonic-clonic seizures but in only 4 (10%) controls.

In our hospital, measurement of the amylase level is part of our routine serum chemistry evaluations. For some time, one of us has seen that amylase levels are often elevated after a generalized seizure. Our chart review seems to support that observation. The source of this elevation is not clear but may be salivary. We have seen cases in which such patients had extensive and negative results of abdominal evaluations, such as the computed tomography of the abdomen in the patient we initially described. Knowing that amylase levels may increase after a seizure may save the patient the risk and expense of extensive abdominal evaluations.