Prolactin levels in sudden unexpected death in epilepsy

Area of Science:

• Neurology
• Epilepsy Research
• Forensic Pathology

Background:

• Sudden unexpected death in epilepsy (SUDEP) is a significant concern in epilepsy management.
• The role of terminal seizures in SUDEP remains incompletely understood.
• Elevated serum prolactin levels are observed after seizures in living individuals.

Purpose of the Study:

• To investigate serum prolactin levels in SUDEP cases.
• To determine if raised prolactin levels can serve as an indicator of a terminal seizure in SUDEP.
• To compare prolactin levels in SUDEP with various control groups.

Main Methods:

• Blood samples were collected for prolactin measurement from SUDEP cases and three control groups (epilepsy deaths from other causes, physiologically stressed non-epileptic deaths, and sudden non-epileptic deaths).
• Evidence of terminal seizure in SUDEP cases included specific physical findings at the scene or autopsy.
• Prolactin levels were analyzed and compared across groups.

Main Results:

• Four out of 10 SUDEP cases showed evidence of a terminal seizure.
• Serum prolactin levels were not significantly elevated in the SUDEP group compared to control groups.
• No SUDEP subjects, including those with terminal seizure evidence, exhibited high prolactin levels.

Conclusions:

• Serum prolactin levels are not elevated in SUDEP, irrespective of terminal seizure evidence.
• The time delay for prolactin to peak after a seizure (15-20 minutes) may be too long for detection in SUDEP.
• Prolactin levels are not a reliable biomarker to confirm seizures in SUDEP or to ascertain if SUDEP is always associated with a terminal seizure.