Seizure laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Laboratory Findings

"Obtaining postictal levels of prolactin (within 20 minutes after a convulsive event), lactate (within 1 to 2 hours), ammonia (within several hours), or creatine kinase (especially 24 to 48 hours postictally) can help differentiate convulsive seizures from psychogenic nonepileptic attacks"[1]

[2]


Serum Prolactin Level

Two meta-analyses have quantified the role of an elevated serum prolactin. The first meta-analysis found that:[3] "If a serum prolactin concentration is greater than three times the baseline when taken within one hour of syncope, then in the absence of test "modifiers":

  1. The patient is nine times more likely to have suffered a GTCS as compared with a pseudoseizure positive LR = 8.92 (95% CI (1.31 to 60.91)), SN = 0.62 (95% CI (0.40 to 0.83)), SP = 0.89 (95% CI (0.60 to 0.98))
  2. Five times more likely to have suffered a GTCS as compared with non-convulsive syncope positive LR 4.60 (95% CI (1.25 to 16.90)), SN = 0.71 (95% CI (0.49 to 0.87)), SP = 0.85 (95% CI (0.55 to 0.98)). "

The second meta-analysis found:[4]

  1. "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)."
  2. "Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B).
  3. "The use of serum PRL assay has not been established in the evaluation of status" epilepticus, repetitive seizures, and neonatal seizures (Level U)."

The serum prolactin level is less sensitive for detecting partial seizures.[5]

References

  1. Wu, Ken; Hirsch, Lawrence J.; Babl, Franz E.; Josephson, S. Andrew (2020). "Choosing Anticonvulsant Medications to Manage Status Epilepticus". New England Journal of Medicine. 382 (26): 2569–2572. doi:10.1056/NEJMclde2004317. ISSN 0028-4793.
  2. Nass RD, Sassen R, Elger CE, Surges R (2017). "The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures". Seizure. 47: 51–65. doi:10.1016/j.seizure.2017.02.013. PMID 28288363.
  3. Ahmad S, Beckett MW (2004). "Value of serum prolactin in the management of syncope". Emergency medicine journal : EMJ. 21 (2): e3. PMID 14988379.
  4. Chen DK, So YT, Fisher RS (2005). "Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology. 65 (5): 668–75. doi:10.1212/01.wnl.0000178391.96957.d0. PMID 16157897.
  5. Shukla G, Bhatia M, Vivekanandhan S; et al. (2004). "Serum prolactin levels for differentiation of nonepileptic versus true seizures: limited utility". Epilepsy & behavior : E&B. 5 (4): 517–21. doi:10.1016/j.yebeh.2004.03.004. PMID 15256189.


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