Abubakr Abuhuziefa, Wambacq Ilse
Department of Neurology (AA), University of Mississippi Medical Center, Jackson, MS; and Department of Communication Sciences and Disorders (IW), Montclair State University, Bloomfield, NJ.
Neurol Clin Pract. 2016 Apr;6(2):116-119. doi: 10.1212/CPJ.0000000000000232.
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).
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.
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.
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.
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.
这是一项回顾性研究，旨在确定癫痫监测病房（EMU）中血清催乳素水平对于区分精神性非癫痫发作（PNES）和癫痫发作（ES）的作用。
回顾了2008年至2012年间连续入住EMU的所有患者的记录。选取了诊断为PNES和ES的患者。所有患者均在20分钟内获取血清催乳素水平，催乳素水平升高定义为患者基线值的两倍。共审查了607份记录，389名患者因信息不完整或缺乏临床事件而被排除。
共有218名患者纳入分析。另有18名患者因单纯部分性发作或血清催乳素获取记录时间不明确而被排除。共有146名患者患有PNES，其中42名催乳素水平升高，假阳性率为28.8%。所有22名全身强直阵挛发作患者血清催乳素均升高；然而，32名复杂部分性发作患者中有5名催乳素水平未升高，假阴性率为15.6%。
血清催乳素水平对于区分PNES和ES没有提供任何额外的支持。此外，在此情况下检测血清催乳素水平会给患者增加不必要的采血和经济负担。因此，在EMU中不应常规检测催乳素水平。
本研究提供III级证据，表明84.4%的ES患者和28.8%的PNES患者在发作后血清催乳素升高。
