Peripheral WBC Count and Serum Prolactin Level in Various Seizure Types and Nonepileptic Events

Abstract

Summary:Purpose: To analyze effects of different types of seizures and nonepileptic events as well as effects of seizure duration and lapse between the time of seizure and blood collection on serum prolactin level and peripheral white blood cell (WBC) count.Methods: We prospectively collected blood samples from all patients admitted to our Epilepsy Monitoring Unit at baseline and after an event. Blood samples were analyzed, and serum prolactin level and WBC count were determined. Statistical analyses were performed to evaluate the relation of each type of seizure, its duration, and time lapse between a seizure and collection of blood sample to the serum prolactin level and peripheral WBC count.Results: Serum prolactin level increases above twice the level at baseline after a complex partial seizure or a generalized seizure. Peripheral WBC count is elevated above the upper limit of normal in about one third of cases after a generalized seizure. In generalized seizures, the length of a seizure is positively associated, whereas the lapse time between the seizure onset and blood draw is negatively correlated with the increase in WBC count. Thus the longer the seizure and quicker the blood draw, the higher the WBC count. Conclusions:We conclude that complex partial or generalized seizures are associated with an increase in serum prolactin level. Peripheral WBC count increases significantly after a generalized seizure and is probably transient in nature. Key Words: Seizure-WBC-Prolactin-Nonepileptic eventLeukocytosis.Serum prolactin level is a well-established test to help differentiate epileptic seizures from nonepileptic events (pseudoseizures). Elevation of serum prolactin level is common after complex partial and generalized tonicclonic seizures and to a lesser extent after simple partial seizures (1,2). However, some have questioned the validity of serum prolactin levels in differentiating nonepileptic from epileptic events (3,4).It is generally believed that status epilepticus and to some degree a generalized tonic-clonic seizure may induce leukocytosis (5). However, we did not find any prospective studies evaluating the relation of leukocyte count to a single seizure. The cause of this increase in the leukocyte count also is not well studied.The white blood cell (WBC) count increases after rigorous exercise (6). We hypothesize that elevation of WBC count after a seizure is a result of muscular activity during the seizure. If that is the case, the elevation in WBC should be directly related to the length of generalized tonic-clonic activity. We studied the relation of leukocyte count to the type of seizure, the length of the seizure, and lapse of time between the seizure and collection of the blood sample. METHODSThe data were collected prospectively, but analyzed retrospectively. The Wayne State University Institutional Review Board for human investigations approved the study. The patients were admitted to the Epilepsy Monitoring Unit (EMU) at Harper University Hospital for continuous EEG and CCTV monitoring. E...

Serum Prolactin Level in Children with Febrile Seizure and Epileptic Seizure; Comparative Study

“…This probably explains, why more cases of GTCS and CPS had elevated levels of PL 17 . Shah and colleagues analyzed the time lapse between the time of seizure and blood sampling on serum PL level and observed an inverse correlation between seizure and time lapse between the seizure event and blood sampling 18 . Singh et al, estimated the serum PL within 20 minutes of occurrence of seizure 12 .…”

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

“…91 Other serum measures. Other serum measure studies to differentiate GTC ES from PNES have included the use of elevations in peripheral white blood count, 92 cortisol, 93 creatine kinase, 94 and neuron-specific enolase 95 ; however, there was limited discriminative power of these serological tests in differentiating epilepsy from PNES. 96 Capillary oxygen saturation on pulse oximetry is lower for epilepsy than for PNES.…”

Use of serum prolactin in diagnosing epileptic seizures

“…The terminology of NES was used in one study that did not elaborate on etiology. 15 In one Class I and seven Class II studies, elevated serum PRL measures were positively predictive of a correct diagnosis of GTC or CPS, whereas failure of PRL elevation poorly distinguished between ES and psychogenic NES. Data were insufficient to establish the predictive value of PRL following simple partial seizures.…”

“…One Class I and nine Class II studies compared serum PRL changes following ES and psychogenic NES (table 1). [14][15][16][17][18][19][20][21][22][23] Of these 10 studies, all except one study 15 ascribed psychogenic etiologies to the NES. The terminology of NES was used in one study that did not elaborate on etiology.…”