Generalized Tonic ClonicSeizures

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Abbott and coworkers (21) demonstrated elevations of serum prolactin and cortisol following spontaneous

TABLE 5.2

Postictal Changes in Serum Prolactin

Postictal Elevation

Type of Event

of Serum PRL

Generalized tonic-clonic

seizure

Virtually 100%

Absence seizure

None

Myoclonic seizure

None

Akinetic seizure

None

Complex partial seizure

Most (>80%)

Simple partial seizure

Some (10-20%)

Status epilepticus

None

Psychogenic nonepileptic

seizure

None

GTCS, but only serum Cortisol responded to simulated convulsive seizures. Abbott considered Cortisol a nonspecific response to stress, contrasted with a specific seizure-induced rise in PRL.

Trimble's patients were not monitored by electroencephalography (EEG), but subsequent studies of monitored events confirmed his findings in 80 to 100% of patients with GTCS (22-24). Each of these investigators employed different criteria for significant PRL elevation, such as three-fold elevation of baseline levels or paired t-test comparisons. Most other studies did not include EEG monitoring.

A comparison of serum levels of neuron-specific enolase (NSE) and PRL following single GTCS and complex partial seizures (CPS) showed little change in NSE for most patients. Serum PRL displayed an 80% sensitivity in the detection of CPS or GTCS (25).

A single study examined PRL and beta endorphin in cerebrospinal fluid (CSF) after GTCS. CSF levels of beta endorphin were elevated, but PRL was normal. CSF samples were obtained up to 2 hour postictally, which may have missed changes in greater proximity to the seizure (26).

Fisher (27) demonstrated the utility of capillary blood collected with filter paper as an aid in the diagnosis of seizures. This approach lends itself to outpatient use through the collection of postictal capillary blood samples by the patient's family.

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