Serum prolactin changes in epilepsy and hysteria

The usefulness of post-ictal serum prolactin changes, as an adjunct, in the differentiation of generalized tonic-clonic seizures and complex partial seizures from hysterical pseudoepileptic seizures, was investigated in a double blind study designed to control for variables known to alter prolactin levels. Significant post-ictal hyper-prolactinemia, with a peak at 20 minutes and a fall towards baseline by 1 hour, was found after complex partial seizures, generalized tonic-clonic seizures and after bilateral, unmodified ECT, but not after hysterical pseudoepileptic seizures or in stressed, non-epileptic controls. A proportionate increase in peak prolactin levels of at least thrice baseline values was found to best differentiate genuine seizures from pseudoepileptic seizures. Postictal hyperprolactinemia is a sensitive biochemical marker of a genuine seizure and of potential use in the differentiation of epileptic from hysterical pseudoepileptic seizures.