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Diagnostic value of serum prolactin levels in PNES in the epilepsy monitoring unit.

ABSTRACT: Background:This is a retrospective study to determine the usefulness of serum prolactin levels in the epilepsy monitoring unit (EMU) for distinguishing psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES). Methods:All the records of consecutive patients admitted to the EMU between 2008 and 2012 were reviewed. Patients with a diagnosis of PNES and ES were selected. Serum prolactin level was obtained within 20 minutes for all patients, and an elevated prolactin level was defined as twice the patient's baseline value. A total of 607 records were reviewed, and 389 patients were excluded because of incomplete information or lack of a clinical event. Results:A total of 218 patients were included in the analysis. A further 18 patients were excluded because of simple partial seizures or because the documented time of obtaining serum prolactin was not clear. A total of 146 patients had PNES, of which 42 had elevated prolactin levels, representing a 28.8% false-positive rate. All 22 patients with generalized tonic-clonic seizures had elevated serum prolactin; however, 5 of 32 patients with complex partial seizures did not have an elevated prolactin level, representing a 15.6% false-negative rate. Conclusions:Serum prolactin levels do not provide any additional support for distinguishing PNES from ES. Furthermore, serum prolactin levels in this setting add unnecessary blood draws and financial burden for the patients. Therefore, prolactin levels should not be obtained routinely in the EMU. Classification of evidence:This study provides Class III evidence that postevent elevation of serum prolactin occurs in 84.4% of patients with ES and 28.8% of patients with PNES.

SUBMITTER: Abubakr A

PROVIDER: S-EPMC5720616 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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Diagnostic value of serum prolactin levels in PNES in the epilepsy monitoring unit.

Abubakr Abuhuziefa A Wambacq Ilse I

Neurology. Clinical practice 20160401 2

<h4>Background</h4>This is a retrospective study to determine the usefulness of serum prolactin levels in the epilepsy monitoring unit (EMU) for distinguishing psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES).<h4>Methods</h4>All the records of consecutive patients admitted to the EMU between 2008 and 2012 were reviewed. Patients with a diagnosis of PNES and ES were selected. Serum prolactin level was obtained within 20 minutes for all patients, and an elevated prolactin leve ...[more]

PMID: 29377044

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Project description:ObjectiveTo study the outcome of patients with psychogenic non-epileptic seizures (PNES) after their diagnosis in the epilepsy monitoring unit (EMU).MethodsPatients diagnosed in our EMU with definite PNES between January 2009 and May 2023 were contacted by phone, and those who agreed to participate were asked a set of predetermined questions. Comparative analyses were carried out on several variables before and after diagnosis: number of participants with daily PNES, number of visits to the emergency department, number of participants who consulted their general practitioner or a neurologist outside of a scheduled follow-up, number of participants who took antiseizure medications (ASMs) or psychotropic drugs, and employment status.ResultsOut of the 103 patients with a definite diagnosis of PNES, 61 patients (79% female) accepted to participate in our study. The median age at PNES onset was 35 years, and the median delay to diagnosis was 3 years. Almost two-thirds (62%) were receiving ASMs and 40% psychotropic drugs. The mean stay at the EMU was 5 days. PNES diagnosis was explained to almost all patients (97%) by the end of their EMU stay and was well-accepted by most (89%). When contacted, 46% of participants no longer had PNES; 32% mentioned that their PNES had ceased immediately upon communication of the diagnosis. The median follow-up duration was 51 months. Fewer patients had daily seizures after the diagnosis (18 vs. 38%; p < 0.0455). Similarly, the median number of emergency department visits was significantly lower (0 vs. 2; p < 0.001). Only 17 patients consulted their general practitioner (vs. 40, p < 0.001) and 20 a neurologist (vs. 55, p < 0.001) after a PNES attack outside of a scheduled follow-up. The use of ASMs was also significantly reduced from 70 to 33% (p < 0.01), with only one still taking an ASM for its antiseizure properties. Significantly more participants were working at last follow-up than at PNES diagnosis (49 vs. 25%; p < 0.001).ConclusionOur study revealed a relatively favorable long-term outcome of definite PNES diagnosed in the EMU that translated in significant reductions in PNES frequency, health care utilization and ASM use, as well as a significant increase in employment rate.

Project description:ObjectiveSome patients with genetic generalized epilepsy (GGE) may present with ambiguous and atypical findings and even focal brain abnormalities. Correct diagnosis may therefore be difficult.MethodsWe retrospectively collected six patients investigated on the epilepsy monitoring unit with MRI abnormalities mimicking focal cortical dysplasia (FCD-like) or heterotopias, but with semiology and EEG features of GGE. We compared them to four additional patients with GGE and nonmigratory abnormalities.ResultsAll six patients presented with frontal MRI lesions: radial ("transmantle," n = 4), cortical-subcortical (n = 1), and periventricular heterotopia (n = 1). Five had positive family histories. Semiologic lateralizing signs compatible with the lesion were seen in four. Five patients had 3/s spike-wave complexes, with an asymmetric appearance in three. Regional EEG changes matched with the side of the abnormality in three patients. Invasive EEG (n = 2) or postoperative outcomes (n = 3) argued against an ictogenic role of the MRI abnormalities. Histology showed mild malformation of cortical development, but no focal cortical dysplasia. The six patients were finally diagnosed with juvenile myoclonic epilepsy (n = 2), juvenile absence epilepsy (n = 2), or GGE not further specified (nfs, n = 2). Compared to these patients, the other four (final diagnoses: childhood absence epilepsy, n = 1; perioral myoclonia with absences, n = 1; and GGE nfs, n = 2) had no lateralizing EEG findings.SignificancePatients with GGE may have coincidental MRI abnormalities. These cases are challenging as frontal epilepsy and GGE can present with similar semiologies. GGE with coincidental FCD-like lesions/heterotopias is in particular difficult to diagnose as patients have more lateralizing features (in semiology and EEG) than those with tumors. A detailed noninvasive presurgical evaluation may be justified. We point out red flags that may help to distinguish GGE from frontal epilepsy, even in the presence of brain abnormalities: 3/s spike waves (even if asymmetric), changing lateralizing signs at different times, and a positive family history hinting at GGE.

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Diagnostic value of serum prolactin levels in PNES in the epilepsy monitoring unit.

Publications

Diagnostic value of serum prolactin levels in PNES in the epilepsy monitoring unit.

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