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109 DETERMINANTS OF ORDERING SERUM PROLACTIN AND ITS UTILITY IN PATIENTS WITH SEIZURES AND PSEUDOSEIZURES.
  1. S. Mannepalli,
  2. T. Manthabala,
  3. M. Panda,
  4. B. Moffitt
  1. University of Tennessee, College of Medicine, Chattanooga Unit, Chattanooga, TN

Abstract

Background Prolactin, a neurohormone, is released at the onset of seizures, peaking within 15 to 20 minutes, and declines to baseline levels within an hour. Prolactin usually fails to rise significantly following pseudoseizures and therefore can be used to differentiate between seizures and pseudoseizures. In an emergency room study the sensitivity of prolactin in diagnosing seizures was 42% and specificity was 82%.

Purpose and Hypothesis To study the prevalence and patient and physician factors associated with the ordering of serum prolactin. These determinants influencing the ordering of prolactin in seizure/pseudoseizure patients have not been studied. We hypothesized that serum prolactin will be ordered more frequently on resident patients compared to other physicians. Patients with a past history of seizures and substance abuse will be less likely to have serum prolactin ordered.

Methods Retrospective chart review of patients 18 years and older presenting with admitting diagnosis of seizures/pseudoseizures for a period of 6 months. Statistical analyses were done to determine the prevalence and timing of ordering prolactin, sensitivity and specificity of prolactin, and physician and patient characteristics in ordering prolactin. Prolactin > 20 ng/mL at 90 minutes postictally was considered positive.

Results Of the 395 patients admitted with diagnosis of seizures/pseudoseizures, 38 had serum prolactins ordered. The prevalence of ordering prolactin was 96.20 cases/1,000. Among these, 47% had prolactin drawn within 90 minutes. Emergency physicians ordered most prolactin levels, 68.42%. Sixty percent of patients had a past history of seizure, 58% a history of substance abuse, 53% had a history of psychiatric disorder, and 21% were on antipsychotic medications. The sensitivity and specificity of elevated prolactin obtained within 90 minutes for seizures were 38.46% and 80%, respectively. The sensitivity of normal prolactin in diagnosing pseudoseizures was 80%.

Conclusion In our study emergency room physicians ordered most prolactins. The high sensitivity of normal prolactin in patients with pseudoseizures emphasizes its utility in diagnosing patients presenting with possible diagnosis of pseudoseizures. We propose that serum prolactin levels should be a part of basic seizure investigation protocol. Obtaining serum prolactin levels is easy, affordable, and available widely and is useful as a diagnostic tool when obtained within a short time following seizure.

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