Role of Biomarkers in Differentiating New-onset Seizures from Psychogenic Nonepileptic Seizures

Abstract

Introduction:Review of literature revealed very limited studies considering a combination of serum prolactin (PRL) and serum creatine kinase (CK) as markers for differentiating epileptic and psychogenic nonepileptic seizures (PNES). Therefore, in the present study, we analyzed the role of serum PRL and serum CK, individually and in combination.Methodology:This prospective study was conducted in a tertiary care medical teaching hospital over a period of 18 months. Patients aged over 15 years suspected to have new-onset seizures presenting within 5 h of ictus were included in this study. CK, serum PRL was measured at 0–1, 1–3, and 3–5 h after seizures.Results:Hundred subjects were studied for the role of serum PRL and serum CK in differentiating epileptic and PNES. The mean age was 42.24 years with a male:female ratio of 1.27:1. All patients of generalized tonic–clonic seizures (GTCS), who presented within 1 h, had elevated PRL, whereas 75% of patients with partial seizures had elevated PRL within 1 h of presentation. Nearly 91.66% of patients with GTCS who presented within 1 h had elevated CPK, whereas 70% of patients with partial seizures had elevated CPK. None of the patients diagnosed with PNES showed rise in either of the markers.Conclusion:In the present study, none of the patients with PNES showed raise in either serum PRL or CK. However, there was no correlation between the types of seizure and PRL or serum CK levels.

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

“…GTC seizures are known to induce acute systemic increases in several plasma metabolites, enzymes, and hormones, such as prolactin, [5][6][7][8] creatine kinase (CK; typically within a few hours), 6,[9][10][11] lactate, 12,13 ammonium, 14,15 adrenocorticotropic hormone, 16 and cortisol. 8,16 Prolactin, 6,17,18 lactate, 19 and CK 6,10 increases were evaluated as markers for differentiating GTC seizures, syncope and nonepileptic psychogenic seizures. 20 GTC seizures were also found to be associated with an increase in multiple inflammatory parameters.…”

Serum prolactin level and lactate dehydrogenase activity in patients with epileptic and nonepileptic seizures

“…In contrast to these studies, Shukla et al [ 15 ] revealed similar prolactin levels and also similar percentages of patients with abnormal prolactin levels in their comparison of PNES and true complex partial seizures with or without secondary generalization, when measured within 15 to 20 minutes of seizure. Javali et al [ 16 ] demonstrated in 100 patients with new-onset seizures that serum prolactin levels measured within 1 hour were elevated in all subjects with generalized tonic-clonic seizures and 75% of patients with focal seizures. They also showed that none of the participants with PNES had an increase in PRL levels.…”

Management of Self-Injurious Behavior, Aggression, and Psychogenic Non-Epileptic Seizures in Patients With Tuberous Sclerosis: A Case Report With a Review of Literature

“…A study by Javali et al found that 75% of patients with generalized tonic-clonic seizures (GTCS) had an increased level of PRL with a mean of 1379 U/L. While none of the patients with PNES have increased levels of PRL and had a mean of CK of 58 U/L [ 8 ].…”