S ince the initial paper by Trimble in 1978 1 highlighting postictal levels of serum prolactin as a way to separate epileptic from nonepileptic seizures, PubMed has logged approximately 300 articles retrievable by the search terms "epilepsy" and "prolactin." Despite this considerable body of work, the role of serum prolactin in diagnosis of seizures remains uncertain. In this issue of Neurology ® Clinical Practice, Abubakr and Wambacq 2 evaluated serum prolactin levels 20 minutes after a behavioral seizure-like event in 200 patients undergoing video-EEG recordings in an epilepsy monitoring unit. Using the video-EEG as the "gold standard," they found prolactin to be elevated in all 22 patients with tonic-clonic seizures, 27 of 32 patients with complex partial seizures, and 42 of 146 patients with psychogenic seizures. For tonic-clonic seizures sensitivity was 100% and for complex partial seizures sensitivity was 84.4%. Overall, elevated prolactin occurred in 84.4% of patients with epileptic events and 28.8% of patients with nonepileptic events. Sensitivity and specificity in this study were comparable to the pooled sensitivity (52.6%) and specificity (92.8%) for all epileptic seizures in a previously published American Academy of Neurology Therapeutics and Technology Assessment Subcommittee review of 10 studies. 3 Because the present study includes a large number of patients evaluated at a single center, it provides useful new information on the utility of serum prolactin as a marker for seizures. Certain study limitations need to be considered. As the authors indicate, the study was retrospective and was performed in a selected population of patients referred to an epilepsy monitoring unit. Obtaining prolactin assay 20 minutes after a seizure in the outpatient setting is difficult, although possible by a finger-stick method. 4 Some conditions that can elevate serum prolactin, such as syncope, 5 are not well represented in video-EEG monitoring populations. The criterion used in this study for identifying elevated serum prolactin is debatable, because different studies 3 require either a doubling over baseline or elevation above some absolute value ranging from 16.5 to 45 ng/mL. The absolute value matters; for example, a doubling of serum prolactin from 1 to 2 ng/mL would not represent an impressive increase. My own view is that prolactin should at least double and achieve a minimum value of 15 ng/mL in order to meet criteria for marking an epileptic seizure. Conditions that affect baseline serum prolactin, such as dopaminergic or neuroleptic medications, pregnancy, or pituitary abnormalities, should be excluded. The main debatable issue with the findings of this study is the conclusion that "serum prolactin levels do not provide any additional support for distinguishing psychogenic non-epileptic seizures from epileptic seizures." This is an interpretive matter of glass half-full or half-empty. This gloomy interpretation is not supported by the sensitivity and specificity reported in the study. In an epilepsy moni...

Background: Accidents and injuries are one of the most important causes of disability and death in developed and developing countries. Awareness of the dimensions and causes of accidents and injuries can be beneficial for health policymakers. Therefore, this study was conducted to aim of estimation the incidence rate and evaluation of epidemiological pattern of accidents and incidents in the Khomein City. Methods: This descriptive-analytical study from cross-sectional type was carried out using data from the national program of accidents and injuries registry in the Khomein Province in 2017. The study population is injured by accidents referring to the hospital. To calculate the age-standardized incidence rate (ASR) was used from the world standard population. Data analysis was performed using SPSS software version 20 and at an error level of 5%. Results: The mean and standard deviation of age the injured was 32.9±18.8. The annually Incidence Rate (IR) of accidents and injuries was 939.1 cases per 100,000 people, while the age-standardized incidence rate (ASR) were estimated to be 917 per 100,000 people. In total, the sex ratio (male to female) in all accidents is 2.46, that this proportion in the age group of 20-29 years was maximum. The most incidents occurred in both sexes were reported motor vehicle (car) accident (32.2%), motorcycle accident (31.7%), pedestrian accident (16.2%) and poisoning (6.2%), respectively. Between gender variable and type of incident was observed significant difference (P<0.001). Cases of suicide attempt in the female group were 6.5 times higher than the men group. Conclusion:The incidence rate of traffic crashes in the city of Khomein is several times the provincial and national levels, for this reason, this city is considered as a high-risk and at-risk regions for traffic accidents in the country. Therefore, should be In addition to the optimizing the roads and removing the Accident-prone spots, The Naja Rahvar Police with by imposing strict and accurate traffic rules and more control of the drivers behavior, are attempting to reduce the occurrence of accidents. The high occurrence of poisonings and suicide attempt several times in the women s group is warning danger for the authorities to take preventive policies and applying cultural mechanisms to reduce this ratio to be stepped up.