Use of serum prolactin in diagnosing epileptic seizures

Abstract

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 ...

Quality improvement in neurology: AAN epilepsy quality measures

“…The literature search identified 160 relevant recommendation statements from 19 guidelines [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and 2 consensus papers. [32][33] Review by the co-chairs and facilitator resulted in 20 recommendation statements that were rated highest on importance, validity, strength of evidence, and gaps in care to serve as the evidence base for 12 candidate measures.…”

Serum prolactin levels in diff erential diagnosis of pediatric epileptic and nonepileptic (pseudo-SEIZURES) seizures

“…We believe that the age increase in the NES group may be due to conversions. The American Academy of Neurology suggests evaluation of PRL levels in adults and older children to diff erentiate generalized tonic-clonic seizures or complex partial seizures from psychogenic NES at 10-20 min following the attack and interpreting the results in favor of generalized tonic-clonic or partial seizures in case of increased results (14). Yerby et al (13) report that the postictal serum PRL levels used for diff erential diagnosis of ES and NES are not increased in nonepileptic cases in contrast to epileptic cases, and Luef (15) reports that the 15-20 min serum PRL increase may be helpful in diff erentiating between psychogenic and complex partial and generalized tonic-clonic seizures but may not be of help in diff erentiating between epileptic seizure and syncope.…”

“…In these studies, Oribe et al (16) showed that serum PRL levels were as high as those seen in epilepsies in 21 patients in whom they induced syncopes with tilt test. Leuf (15) showed that PRL was not helpful in diff erentiation of epileptic seizure and syncope; and fi nally Chen et al (14) showed that serum PRL levels were not helpful in diff erentiating epileptic seizure and syncope. Based on the data recorded in our study, we determined that the time of measurement was the only factor aff ecting PRL level, and not any other factor (gender, EEG pathology, antiepileptic drug use, duration of seizures, etc.).…”

Paroxysmal Disorders in Neuropsychiatry: Why Episodic Disorders Must be Accounted For

“…10-20 minutes) after a tonic clonic seizure or CPS and controversially simple partial may be elevated (inconsistent in 60%) [48][49][50][51][52][53].…”