Prolactin and cortisol levels in seizure disorders

Area of Science:

• Neurology
• Endocrinology
• Clinical Neurophysiology

Background:

• Distinguishing epileptic seizures from psychogenic pseudoseseizures is clinically significant.
• Hormonal changes, specifically prolactin and cortisol, are investigated as potential biomarkers for seizure types.

Purpose of the Study:

• To evaluate the acute effects of generalized tonic-clonic seizures (GTCS), partial seizures, and pseudoseizures on serum prolactin (PRL) and cortisol levels.
• To determine if postictal PRL and cortisol measurements can aid in differentiating these seizure types.

Main Methods:

• Serum PRL and cortisol levels were measured at 20, 60, and 120 minutes postictally in patients experiencing GTCS, partial seizures, and pseudoseizures.
• Measurements were also taken in healthy controls and epilepsy patients during the interictal phase.

Main Results:

• Elevated PRL levels (> 25 ng/ml) were observed in 68.33% of GTCS and 11.11% of partial seizure cases, peaking within 30 minutes postictally.
• No significant PRL elevation was found in pseudoseizure patients.
• Elevated cortisol levels were observed in 45% of GTCS, 55.55% of partial seizures, and 66.66% of pseudoseizure patients during the 60-120 minute postictal period.

Conclusions:

• Postictal prolactin (PRL) measurement is a valuable tool for differentiating generalized tonic-clonic seizures (GTCS) from pseudoseizures.
• While elevated cortisol is a non-specific stress response, postictal PRL elevation strongly suggests an epileptic seizure, particularly GTCS.