Department of Pediatrics, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, 401121, China.
Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China.
Epilepsy Res. 2021 Jan;169:106508. doi: 10.1016/j.eplepsyres.2020.106508. Epub 2020 Nov 24.
Psychogenic non-epileptic seizures (PNES) are conversion disorders with functional neurological symptoms that can resemble epileptic seizures (ES). We conducted a systematic review to obtain an overview of the value of prolactin (PRL) levels in the differential diagnosis between PNES and ES.
We searched PubMed, EMBASE, and Cochrane Library databases for studies published up to June 4th, 2020. Published studies were included if they fulfilled the following criteria: original research on PRL changes after ES and PNES. By applying Bayes' theorem, we calculated the predicted values of PRL with pretest probabilities of 90 % and 75 % in ES.
Sixteen studies were included in this review. All the studies showed that PRL levels increase after ES, especially 10-20 min after ES, when the elevation was most obvious. In studies where capillary PRL level measurements were included, the median sensitivity in the diagnosis of ES (all epileptic seizure types), generalized tonic clonic seizures (GTCS), focal impaired awareness seizures (FIAS), and focal aware seizures (FAS) was 67.3 %, 66.7 %, 33.9 %, and 11.1 %, respectively. The median specificity in the diagnosis of ES was 99.1 %. By using Bayes' theorem, when we used the median specificity and sensitivity for predictive value calculation, assuming a pretest probability of 90 %, a positive PRL measure was highly predictive (99 %) of all types of ES, and negative predictive values were all below 30 %. When we used the lowest specificity and sensitivity for predictive value calculation, assuming a pretest probability of 75 %, ES and GTCS had positive predictive values of 77.2 % and 81.0 %, respectively; the negative predictive values of PRL in ES and GTCS were 26.2 % and 29.6 %, respectively.
The use of PRL could be a useful adjunct to differentiate GTCS from PNES. However, PRL levels are of limited use for differentiating FIAS or FAS from PNES, and a negative PRL measure is not predictive of PNES.
心因性非癫痫性发作（PNES）是一种具有功能性神经症状的转换障碍，可与癫痫发作（ES）相似。我们进行了一项系统综述，以了解催乳素（PRL）水平在 PNES 和 ES 鉴别诊断中的价值。
我们检索了 PubMed、EMBASE 和 Cochrane Library 数据库，以获取截至 2020 年 6 月 4 日发表的研究。如果研究符合以下标准，我们将其纳入：关于 ES 和 PNES 后 PRL 变化的原始研究。通过应用贝叶斯定理，我们计算了 ES 中 PRL 的预测值，预测试验概率为 90%和 75%。
本综述纳入了 16 项研究。所有研究均表明，ES 后 PRL 水平升高，尤其是 ES 后 10-20 分钟时升高最明显。在包括毛细血管 PRL 水平测量的研究中，ES（所有癫痫发作类型）、全面强直阵挛发作（GTCS）、局灶性意识障碍发作（FIAS）和局灶性意识发作（FAS）的诊断中，PRL 的中位敏感性分别为 67.3%、66.7%、33.9%和 11.1%。ES 诊断的中位特异性为 99.1%。通过应用贝叶斯定理，当我们使用预测值计算的中位数特异性和敏感性时，假设预测试验概率为 90%，阳性 PRL 测量对所有类型 ES 的预测高度（99%），阴性预测值均低于 30%。当我们使用预测值计算的最低特异性和敏感性时，假设预测试验概率为 75%，ES 和 GTCS 的阳性预测值分别为 77.2%和 81.0%；ES 和 GTCS 中 PRL 的阴性预测值分别为 26.2%和 29.6%。
PRL 的使用可能有助于区分 GTCS 和 PNES。然而，PRL 水平对于区分 FIAS 或 FAS 与 PNES 的作用有限，且阴性 PRL 测量不能预测 PNES。
