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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

From Stanford University, Palo Alto, CA.

Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.

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).

Robert S. Fisher, MD, is supported by the Maslah Saul MD Chair, the Susan E. Horngren Fund, and the James and Carrie Anderson Epilepsy Research Fund.

Disclosure: The authors report no conflicts of interest.

This guideline was approved by the Therapeutics and Technology Assessment Subcommittee on November 19, 2004; by the Practice Committe on April 13, 2005; and by the Board of Directors on June 25, 2005.

Received January 6, 2005. Accepted in final form July 5, 2005.

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