Serum prolactin and cortisol levels in evaluation of pseudoepileptic seizures

Pritchard, Paul B.; Wannamaker, Braxton B.; Sagel, Julius; Daniel, Charlene M.

doi:10.1002/ana.410180115

Cited by 77 publications

(49 citation statements)

References 10 publications

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“…Differentiation between epileptic and psychoge nic seizures may pose several problems. Measurement of serum prolactin immediately after a seizure has been claimed to differentiate between both seizure types [6,26]. Increases in prolactin after epileptic seizures were observed in 40-100% of the patients [I, 25,36], whereas no such change was documented during a psychogenic seizure.…”

Section: Discussionmentioning

confidence: 99%

“…Cortisol has also been shown to increase during seizures [26]; this probably reflects changes in ACTH secretion. The half-life of 123 min for cortisol after the seizure in our pa tients with epileptic seizure is twice as high as that after a bolus injection of cortisol to healthy subjects, which is 66 min [13].…”

Section: Discussionmentioning

confidence: 99%

“…Serum norepinephrine was lower in patients compared to healthy subjects (p<0.05). The simultaneous elevation of serum prolactin, thyrotropin, growth hor mone, and cortisol points to a central stimulation of the hypothalamic-pituitary axis during an epileptic seizure, but not during seizures of psychogenic origin.Following a grand mal or complex partial seizure most patients show a rise in serum prolactin levels [1,2,6,12,13,18,22,25,26,35,36]. Electroconvulsive treatment also eli cits in humans a rise in serum prolactin, adrenocortotropic hormone (ACTH), and thyrotropin [4,20,21,23].…”

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confidence: 99%

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Epileptic but Not Psychogenic Seizures Are Accompanied by Simultaneous Elevation of Serum Pituitary Hormones and Cortisol Levels

Rao

Stefan²,

Bauer³

1989

Neuroendocrinology

101

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The circadian rhythm of serum prolactin was determined in 12 patients with seizures, and 28 age- and sex-matched healthy subjects (14 men and 14 women). Blood was also collected every 15 min for 2 h immediately after a simultaneously video/EEG-documented epileptic (6 patients) and psychogenic seizure (5 patients) for the determination of prolactin, thyrotropin, growth hormone, cortisol, melatonin, catecholamines and serotonin. During the seizure-free interval, the circadian profile of serum prolactin was lower in female patients than in healthy women. Serum prolactin, thyrotropin, growth hormone, and cortisol were increased postictally, followed by a decrease, after a grand mal or complex partial seizure, but not after a psychogenic seizure in comparison to baseline serum hormone levels obtained during the same time on a seizure-free day. During the seizure and for 2 h afterwards, blood serotonin, serum melatonin, dopamine, and epinephrine did not alter and were within the reference limits of healthy subjects. Serum norepinephrine was lower in patients compared to healthy subjects (p < 0.05). The simultaneous elevation of serum prolactin, thyrotropin, growth hormone, and cortisol points to a central stimulation of the hypothalamic-pituitary axis during an epileptic seizure, but not during seizures of psychogenic origin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Epileptic but Not Psychogenic Seizures Are Accompanied by Simultaneous Elevation of Serum Pituitary Hormones and Cortisol Levels

Rao

Stefan²,

Bauer³

1989

Neuroendocrinology

101

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“…91 Other serum measures. Other serum measure studies to differentiate GTC ES from PNES have included the use of elevations in peripheral white blood count, 92 cortisol, 93 creatine kinase, 94 and neuron-specific enolase 95 ; however, there was limited discriminative power of these serological tests in differentiating epilepsy from PNES. 96 Capillary oxygen saturation on pulse oximetry is lower for epilepsy than for PNES.…”

Section: Pnesmentioning

confidence: 99%

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

Voon¹,

Cavanna²,

Coburn³

et al. 2016

JNP

131

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Much is known regarding the physical characteristics, comorbid symptoms, psychological makeup, and neuropsychological performance of patients with functional neurological disorders (FNDs)/conversion disorders. Gross neurostructural deficits do not account for the patients' deficits or symptoms. This review describes the literature focusing on potential neurobiological (i.e. functional neuroanatomic/neurophysiological) findings among individuals with FND, examining neuroimaging and neurophysiological studies of patients with the various forms of motor and sensory FND. In summary, neural networks and neurophysiologic mechanisms may mediate "functional" symptoms, reflecting neurobiological and intrapsychic processes. J Neuropsychiatry Clin Neurosci 2016; 28:168-190; doi: 10.1176/appi.neuropsych.14090217 Functional neurological disorders (FNDs; or psychogenic neurological symptoms), also known as conversion disorder, are a classic neuropsychiatric disorder, existing in the border between neurology and psychiatry. Unexplained neurological symptoms are common, occurring in up to one-third of patients in neurological outpatient clinics.1 Relative to disorders such as Parkinson's disease, FND is associated with similar levels of disability and physical quality of life with poorer mental health quality of life. 2 The prognosis is poor, with a recent reviewshowing that up to 40% of patients with FND report similar or worse outcomes at 7-year follow-up. 3 Given the frequency, consequences, prognosis, and burden, FND has been called a "crisis for neurology." 4 Despite this, FND is poorly understood. In the last decade, an increasing number of studies have focused on underlying neurobiological mechanisms. FND is defined in DSM-5 as the presence of one or more symptoms of altered voluntary or sensory function, with clinical findings providing evidence of incompatibility between the symptom and recognized neurological or medical conditions.5 The DSM-5 diagnosis differs from that of the DSM-IV diagnosis of conversion disorder by adding the criterion of incorporating physical diagnostic features and by relegating to the accompanying text the criteria requiring (a) an association with psychological stressors and (b) the exclusion of malingering or factitious disorder to make the diagnosis. DSM-5 FND diagnosis criteria now allow for potential greater interrater reliability, making them appropriate for research studies and greater compatibility with specialtyspecific diagnoses including psychogenic movement disorder (PMD) and psychogenic nonepileptic seizures (PNES). 6The putative biopsychosocial mechanisms underlying FND are complex and have been extensively reviewed.7 Our review focuses on the physiological mechanisms that may underlie FND and does not specifically focus on the extensive literature on the antecedents of early childhood experiences and temperament (Figure 1). At the outset, regarding the proposed model, we acknowledge that predisposing factors for functional neurological symptoms are not limited to genetics, te...

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“…One Class I and nine Class II studies compared serum PRL changes following ES and psychogenic NES (table 1). [14][15][16][17][18][19][20][21][22][23] Of these 10 studies, all except one study 15 ascribed psychogenic etiologies to the NES. The terminology of NES was used in one study that did not elaborate on etiology.…”

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confidence: 99%

Use of serum prolactin in diagnosing epileptic seizures

Sandstrom

Anschel²

2005

Neurology

201

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Abstract-Objective:The purpose of this article is to review the use of serum prolactin assay in epileptic seizure diagnosis. Methods: The authors identified relevant studies in multiple databases and reference lists. Studies that met inclusion criteria were summarized and rated for quality of evidence, and the results were analyzed and pooled where appropriate. Results: Most studies used a serum prolactin of at least twice baseline value as abnormal. For the differentiation of epileptic seizures from psychogenic nonepileptic seizures, one Class I and seven Class II studies showed that elevated serum prolactin was highly predictive of either generalized tonic-clonic or complex partial seizures. Pooled sensitivity was higher for generalized tonic-clonic seizures (60.0%) than for complex partial seizures (46.1%), while the pooled specificity was similar for both (approximately 96%). Data were insufficient to establish validity for simple partial seizures. Two Class II studies were consistent in showing prolactin elevation after tilt-test-induced syncope. Inconclusive data exist regarding the value of serum prolactin following status epilepticus, repetitive seizures, and neonatal seizures. Recommendations: Elevated serum prolactin assay, when measured in the appropriate clinical setting at 10 to 20 minutes after a suspected event, is a useful adjunct for the differentiation of generalized tonic-clonic or complex partial seizure from psychogenic nonepileptic seizure among adults and older children (Level B). Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B). The use of serum PRL assay has not been established in the evaluation of status epilepticus, repetitive seizures, and neonatal seizures (Level U). NEUROLOGY 2005;65:668-675 Prolactin (PRL) release from the pituitary is controlled by the hypothalamus via a PRL inhibitory factor, now believed to be dopamine.1 It has been hypothesized that ictal epileptic activity in the mesial temporal structures may propagate to the hypothalamus, altering the hypothalamic regulation of PRL release. 2Trimble first demonstrated that generalized tonicclonic seizures, but not nonepileptic seizures (NESs), could raise serum PRL.3 Despite subsequent confirmatory findings, the sensitivity and specificity of serum PRL assay for diagnosis of epileptic seizures (ESs) remain uncertain. Utility of PRL assays for diagnosis of seizures depends upon the study design, standard of seizure classification, and criteria for abnormal PRL elevation. Additional uncertainty arises from the circadian fluctuations of serum PRL, demonstrating surges of 50 to 100% prior to awakening from sleep, although PRL serum levels otherwise are stable during the waking state.4 PRL concentrations usually are higher in females than in males, 5 and higher in persons with epilepsy than in healthy individuals. 6 In a study that measured baseline PRL every 20 minutes over 24 hours in 20 healthy controls and 17 people with epilepsy, 5 no female had baseline PRL exceeding 700 U/mL, and no ...

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Serum prolactin and cortisol levels in evaluation of pseudoepileptic seizures

Cited by 77 publications

References 10 publications

Epileptic but Not Psychogenic Seizures Are Accompanied by Simultaneous Elevation of Serum Pituitary Hormones and Cortisol Levels

Epileptic but Not Psychogenic Seizures Are Accompanied by Simultaneous Elevation of Serum Pituitary Hormones and Cortisol Levels

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

Use of serum prolactin in diagnosing epileptic seizures

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