Clinical utility of serum prolactin and lactate concentrations to differentiate epileptic seizures from non-epileptic attacks in the emergency room

AbstractTransient loss of consciousness (TLOC) is a frequent cause of referral to an emergency room. In view of the impact on treatment and the patients’ daily life activities (e. g. profession, driving license), an accurate and timely diagnosis is of uttermost importance. This article provides key features and suggests a practical step-by-step approach of how to differentiate syncope, epileptic and psychogenic non-epileptic seizures as the commonest causes of nontraumatic TLOC.

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Use of serum prolactin in diagnosing epileptic seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

Neurology ◽

10.1212/01.wnl.0000234968.40364.31 ◽

2006 ◽

Vol 67 (3) ◽

pp. 544-545

Author(s):

S. A. Sandstrom ◽

D. J. Anschel ◽

D. K. Chen ◽

Y. T. So ◽

R. S. Fisher

Keyword(s):

American Academy ◽

Technology Assessment ◽

Epileptic Seizures ◽

Serum Prolactin ◽

American Academy Of Neurology

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Serum Prolactin Level in Children with Febrile Seizure and Epileptic Seizure; Comparative Study

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v37i1.16502 ◽

2017 ◽

Vol 37 (1) ◽

pp. 67-71

Author(s):

Kotyal B. Mahendrappa ◽

S. Perumal Sathya ◽

M.N. Suma

Keyword(s):

Comparative Study ◽

Epileptic Seizure ◽

Prolactin Level ◽

Age Groups ◽

Epileptic Seizures ◽

Febrile Seizures ◽

Significant Rise ◽

Serum Prolactin ◽

Cns Infection ◽

Serum Prolactin Level

Introduction: Transient hyperprolactinaemia has been reported to follow unprovoked seizures, a finding proposed to be useful in the differential diagnosis of epilepsy. On this basis we conducted a study with an objective to compare the postictal serum prolactin level in children with febrile seizures (FS) and epileptic seizures (ES) to evaluate, whether serum prolactin (PL) could be used a predictor in the diagnosis of ES.Material and Methods: This was a prospective comparative study was conducted on 52 children (26 in febrile seizures group and 26 in epileptic seizure group) in the age group of six months to five years. Children with CNS infection, developmental delay, structural CNS defects or neurological abnormality, metabolic disorders and those on drugs, known to have altered serum prolactin level were excluded. Blood for estimation of serum prolactin was collected within 180 minutes of occurrence of seizure. Level of serum prolactin was quantitatively assayed by chemiluminescence method and the levels were considered high, if values were greater than 23 ng/ml, which is the upper limit of normal for all age groups and both sex.Results: The mean serum prolactin level in epileptic seizures group was 25 ng/ml and that of febrile seizures group was 10.72 ng/ml. High level of serum prolactin was noted in 17 children (77.2%) with GTCS and 3 children (75%) with CPS. None of the children with febrile seizures had significant raise in the level of serum prolactin.Conclusion: There is a significant rise in serum prolactin level in children with epileptic seizures compared to febrile seizures, if measured within 3 hours of occurrence of seizures. Thus, the post-ictal serum prolactin level can be used as an additional investigation to diagnose or predict epileptic seizures in children.

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Prolactin and Cortisol Levels in Various Paroxysmal Disorders in Childhood

PEDIATRICS ◽

10.1542/peds.88.3.486 ◽

1991 ◽

Vol 88 (3) ◽

pp. 486-489

Author(s):

Nathanel Zelnik ◽

Luna Kahana ◽

Anat Rafael ◽

Irit Besner ◽

Theodore C. lancu

Keyword(s):

Epileptic Seizures ◽

Serum Cortisol ◽

Febrile Seizures ◽

Stressful Events ◽

Serum Prolactin ◽

Breath Holding ◽

Control Group ◽

Cortisol Secretion ◽

Paroxysmal Disorders ◽

Cortisol Levels

The hormonal response of the anterior pituitary to various epileptic and nonepileptic events in children was studied. Postictal serum prolactin and cortisol levels were measured in 17 children with epilepsy, 23 with febrile seizures, and 10 with syncope or breath-holding spells. The levels were compared with those of 30 children with nonspecific fever, and 23 afebrile children served as control subjects. Significantly higher (P <.01) prolactin levels (26.5 ± 3.3 ng/mL, mean ± SEM) were found in the epileptic group, compared with levels in children with febrile seizures (13.2±1.0 ng/mL), fever (11.2±0.9 ng/mL), syncope (7.3±0.9 ng/mL), and the control group (7.9± 0.6 ng/mL). In contrast, serum cortisol levels were nonspecifically elevated in the epileptics and patients with febrile seizures or fever only. These findings suggest that elevated prolactin levels may be found after epileptic seizures and much less after febrile seizures, but not after breath-holding spells or syncopal events. Cortisol secretion appears to be nonselectively triggered by all stressful events, such as epileptic and febrile seizures, and fever. Elevated prolactin levels (>15 ng/mL) associated with seizures may help in differentiating epileptic from febrile seizures or syncope.

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