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Published on: May 16, 2019
Macroprolactinomas and epilepsy
Doddabele Deepak1, Christina Daousi, Mohsen Javadpour
1Diabetes and Endocrinology Clinical Research Group, University Hospital Aintree, Liverpool, UK.
Objective:
To assess the prevalence and characteristics of epilepsy in patients with macroprolactinomas. Secondly, to report the response to dopamine agonist (DA) therapy.
Patients:
A case note analysis of all patients with a diagnosis of macroprolactinoma attending a neuroendocrine clinic between 1996 and 2006. Those with epilepsy at diagnosis of macroprolactinoma were examined in detail.
Results:
There were 64 patients with macroprolactinoma and 29 of these had tumours with suprasellar extension compressing/invading the optic apparatus and/or surrounding brain structures. Six of these 29 patients (four men), had a history of seizures at the time of diagnosis, five of whom had features suggestive of temporal lobe epilepsy. None of the other 35 patients had epilepsy. All six patients with epilepsy had invasive prolactinomas on cranial imaging and marked hyperprolactinaemia (median prolactin 369 000 mU/l, range 28 000 to > 750 000). Seizures had been present for a median of 2 years (range 1-23 years) before the diagnosis of macroprolactinoma. A rapid reduction in seizure frequency occurred in all patients with initiation of DA therapy. Four have been seizure-free between 18 months to 15 years despite only small reductions in tumour size.
Conclusions:
Invasive macroprolactinomas can commonly be associated with epilepsy, particularly of temporal lobe origin. It is essential to enquire about epileptic symptoms, as the seizure disorder may have been undiagnosed/untreated for years. DA therapy can reduce ictal frequency and the doses of anti-epileptic drugs. Complete freedom from epilepsy can also occur.
Insights
Epilepsy is common in patients with invasive macroprolactinomas, often presenting as temporal lobe seizures. Dopamine agonist therapy effectively reduces seizure frequency and can lead to complete remission.
Area of Science:
- Neuroendocrinology
- Neurology
- Oncology
Background:
- Macroprolactinomas, a type of pituitary tumor, can cause neurological symptoms due to mass effect.
- Epilepsy is a neurological disorder characterized by recurrent seizures.
- The relationship between macroprolactinomas and epilepsy requires further investigation.
Purpose of the Study:
- To determine the prevalence and characteristics of epilepsy in patients diagnosed with macroprolactinomas.
- To evaluate the effectiveness of dopamine agonist (DA) therapy in managing epilepsy associated with macroprolactinomas.
Main Methods:
- A retrospective case note analysis was conducted on patients with macroprolactinoma diagnosed between 1996 and 2006.
- Detailed examination of patients with epilepsy at the time of macroprolactinoma diagnosis.
- Cranial imaging and prolactin level assessment were performed.
Main Results:
- Six out of 64 (9.4%) macroprolactinoma patients had epilepsy, all with invasive tumors and hyperprolactinemia.
- Five patients presented with features suggestive of temporal lobe epilepsy.
- Dopamine agonist therapy led to a rapid reduction in seizure frequency, with four patients achieving complete seizure freedom.
Conclusions:
- Invasive macroprolactinomas are frequently associated with epilepsy, particularly temporal lobe epilepsy.
- Promptly inquiring about seizure history is crucial for diagnosing potentially long-standing epilepsy.
- Dopamine agonist therapy is effective in managing epilepsy in these patients, potentially reducing anti-epileptic drug requirements and achieving seizure freedom.
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