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Using age-appropriate prolactin levels to diagnose children with seizures in the emergency department
J A Fein1, J M Lavelle, R R Clancy
1Division of Emergency Medicine, Children's Hospital of Philadelphia, PA 19104, USA. fein@email.chop.edu
Insights
Serum prolactin levels can aid in identifying pediatric seizures, but cerebrospinal fluid (CSF) prolactin is not useful for diagnosing generalized seizures in children.
Area of Science:
- Pediatric Neurology
- Biomarkers in Seizure Diagnosis
Background:
- Accurate identification of seizures in children is crucial for timely intervention.
- Serum and cerebrospinal fluid (CSF) prolactin levels are potential biomarkers for seizure activity.
Purpose of the Study:
- To evaluate the diagnostic utility of serum and CSF prolactin levels in children experiencing seizures.
- To determine if prolactin levels can differentiate between children with and without seizures.
Main Methods:
- Prospective cohort study in a pediatric emergency department.
- Analysis of serum and CSF prolactin levels in children with generalized tonic-clonic seizures and ill controls.
- Age-adjusted assessment of serum prolactin levels and comparison of mean CSF prolactin levels.
Main Results:
- Age-adjusted serum prolactin levels were significantly different between seizure and control groups (p < 0.001).
- Positive and negative predictive values for elevated serum prolactin were 68% and 76%, respectively.
- No significant difference in mean CSF prolactin levels was observed between groups; no threshold could differentiate patients.
Conclusions:
- Age-adjusted serum prolactin levels may serve as an adjunct in evaluating pediatric seizure activity.
- CSF prolactin levels are not effective for diagnosing generalized seizures in children in acute care settings.
Objective:
To assess the utility of serum and cerebrospinal fluid (CSF) prolactin levels for identifying children who have experienced seizures.
Methods:
A prospective cohort study was performed in a pediatric ED at an urban children's hospital. A convenience sample of children underwent blood and CSF analyses in the ED over a 2-year period.
Results:
Thirty-five children (aged 3 months-15 years) with generalized tonic-clonic seizures and 48 ill control patients were studied. Both groups included febrile and afebrile patients. The patient characteristics in the seizure and control groups were similar with respect to age, fever, current medications, and blood, urine, and CSF cultures. When serum prolactin levels were assigned age-adjusted dichotomous values of "elevated" or "normal," the rates of elevation between the seizure and control patients were different (p < 0.001). The positive and negative predictive values of these age-adjusted levels were 68% (95% CI 47-85%) and 76% (95% CI 61-87%), respectively. The mean CSF prolactin levels of the seizure and control groups were not significantly different. In addition, there was no single threshold CSF prolactin level that could delineate seizure patients from control patients.
Conclusions:
Age-adjusted serum prolactin levels are useful only as an adjunct in the prospective evaluation of the individual pediatric patient for epileptic seizure activity. CSF prolactin levels are not useful in the diagnosis of generalized seizures in children in the acute care setting.