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

Abubakr, Abuhuziefa; Wambacq, Ilse

doi:10.1212/cpj.0000000000000232

Cited by 12 publications

(10 citation statements)

References 10 publications

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“…However, patients with syncope may also experience mild prolactin elevation 14. Furthermore, a recent study of patients admitted to an epilepsy monitoring unit to distinguish psychogenic from epileptic seizures questioned the role of prolactin, with 29% and 16% false positive and false negative rates, respectively 15. Therefore, physicians ordering prolactin level for assessing seizures or pseudo-seizures should be cognisant of the above limitations.…”

Section: Discussionmentioning

confidence: 99%

Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre

Malik

Aziz

Beshyah

et al. 2019

Sultan Qaboos Univ Med J

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Objectives: This study aimed to evaluate the aetiologies of hyperprolactinaemia in the United Arab Emirates (UAE). Methods: This retrospective study used laboratory databases to identify all patients who underwent evaluation for prolactin at Tawam Hospital, Al Ain, UAE, between 2009 and 2015. Of those 2,280 patients, all patients with low or normal prolactin (n = 1,315) were excluded. Subsequently, charts of the remaining patients (n= 965) with hyperprolactinaemia were reviewed and those with incomplete work-ups or insufficient documentation of the hyperprolactinaemia’s aetiology were excluded (n = 458). Results: A total of 507 patients were included in the study. The average age at prolactin evaluation was 36 ± 13.2 years and the majority (67.1%) of patients were female. The most common reasons for requesting prolactin were menstrual disorders (29.5%), infertility (18%),evaluation of sellar masses (14.3%), ruling out seizures (13.4 %) and monitoring while on psychiatric medications (8.7%). The most common causes of hyperprolactinaemia were prolactinoma (17%), transient hyperprolactinaemia(14.6%), drug-induced side effects (14.4%), polycystic ovarian syndrome (11.8%) and seizure disorder (7.7%). In females, common aetiologies were prolactinomas, transient and idiopathic hyperprolactinaemia, while sellar masses, seizures, chronic kidney disease and acute illnesses were common aetiologies of hyperprolactinaemia in males. The prolactin level varied between the different aetiologies and a level of >250 ng/mL was suggestive of macroprolactinoma. Conclusion: A significant proportion of patients with hyperprolactinaemia have transient hyperprolactinaemia. Before further investigations are carried out, prolactin level assessment should be repeated, especially in patients with mild hyperprolactinaemia.Keywords: Hyperprolactinemia; Prolactinoma; Etiology; Epidemiology; United Arab Emirates.

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Section: Discussionmentioning

confidence: 99%

Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre

Malik

Aziz

Beshyah

et al. 2019

Sultan Qaboos Univ Med J

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“…Usually normal [32,33] High sensitivity for FBTCS (up to 100%) [33] Relevant for bilateral convulsive episodes ES epileptic seizure, PNES psychogenic non-epileptic seizure, SE status epilepticus, FBTCS focal to bilateral tonic-clonic seizure, Sp specificity (%) for PNES or ES explanation that the application of a tuning fork on a precise point on the can induce a seizure. The physician can also stimulate multiple areas, explaining that there is a gradation of the ictogenic power of the tuning fork, depending on the stimulation point (Video 3 illustrates the tuning fork test with an example of answer depending on the stimulation site).…”

Section: Prolactin Levelmentioning

confidence: 99%

“…Concerning the relevant threshold, the increase is generally considered significant if there is a doubling from baseline (if this baseline is available, with a minimum of 15-16.5 ng/ml in post-ictal period) or if there is an increase over 45 ng/ml [32]. Sensitivity can go up to 100% for bilateral tonic-clonic seizures and more than 80% for focal seizures with impaired awareness [9,[31][32][33]. Abubakr and Wambacq have reported a false positive rate of 28% [33].…”

Section: Prolactin Levelmentioning

confidence: 99%

The first-line management of psychogenic non-epileptic seizures (PNES) in adults in the emergency: a practical approach

Toffa

Poirier

Nguyen

2020

Acta Epileptologica

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Distinguishing non-epileptic events, especially psychogenic non-epileptic seizures (PNES), from epileptic seizures (ES) constitutes a diagnostic challenge. Misdiagnoses are frequent, especially when video-EEG recording, the gold-standard for PNES confirmation, cannot be completed. The issue is further complicated in cases of combined PNES with ES. In emergency units, a misdiagnosis can lead to extreme antiepileptic drug escalade, unnecessary resuscitation measures (intubation, catheterization, etc.), as well as needless biologic and imaging investigations. Outside of the acute window, an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug therapy. Early recognition is thus desirable to initiate adequate treatment and improve prognosis. Considering experience-based strategies and a thorough review of the literature, we aimed to present the main clinical clues for physicians facing PNES in non-specialized units, before management is transferred to epileptologists and neuropsychiatrists. In such conditions, patient recall or witness-report provide the first orientation for the diagnosis, recognizing that collected information may be inaccurate. Thorough analysis of an event (live or based on home-video) may lead to a clinical diagnosis of PNES with a high confidence level. Indeed, a fluctuating course, crying with gestures of frustration, pelvic thrusting, eye closure during the episode, and the absence of postictal confusion and/or amnesia are highly suggestive of PNES. Moreover, induction and/or inhibition tests of PNES have a good diagnostic value when positive. Prolactinemia may also be a useful biomarker to distinguish PNES from epileptic seizures, especially following bilateral tonic-clonic seizures. Finally, regardless the level of certainty in the diagnosis of the PNES, it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up.

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“…This was reinforced more recently by Ahmad et al (2019) in a 2-year cross-sectional study involving 90 participants, which found that prolactin levels were higher in those with tonic–clonic epileptic seizures than those with non-epileptic seizures. However, the evidence is not always consistent: in a 4-year retrospective study of 218 participants Abubakr & Wambacq (2016) reported that prolactin did not provide additional support when differentiating between epileptic and psychogenic non-epileptic seizures and concluded that it should not be routinely tested. A summary of when prolactin should be tested is contained in Box 2.…”

Section: Investigationsmentioning

confidence: 99%

Hyperprolactinaemia in the context of psychiatry

et al. 2020

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SUMMARY Advocating for good physical healthcare for their patients is of the utmost importance to psychiatrists. This narrative review focuses on one part of this large goal, the topic of hyperprolactinaemia from the perspective of mental healthcare. For psychiatrists this often includes managing raised prolactin levels in the context of medication. However, they must consider the wider differentials of a raised prolactin level and the possible impact of treatments. For that reason, in this review we start with an overview of prolactin physiology before considering hyperprolactinaemia both in the context of antipsychotic therapy and its wider differentials, including prolactinoma. Investigation and management are considered and key practice points developed.

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

Abstract: 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.

Cited by 12 publications

References 10 publications

Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre

Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre

The first-line management of psychogenic non-epileptic seizures (PNES) in adults in the emergency: a practical approach

Hyperprolactinaemia in the context of psychiatry

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