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Prolactin and Seizure Diagnosis — SCE Neurology MCQ

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ModerateClinical NeurophysiologyProlactin and Seizure DiagnosisSCE Neurology

A 40-year-old man presents after a witnessed generalised tonic-clonic seizure. His serum prolactin level, measured 20 minutes after the event, is significantly elevated. What is the clinical utility of this finding?

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Correct answer: E — It helps distinguish a generalised tonic-clonic seizure from a psychogenic non-epileptic seizure

Serum prolactin levels are transiently elevated following generalised tonic-clonic seizures and complex partial seizures (measured within 20–30 minutes of the event). A prolactin level >2× baseline supports an epileptic seizure over a psychogenic non-epileptic seizure (PNES). It is not elevated after PNES. However, it cannot differentiate seizure types or determine epilepsy type. A: A single elevated prolactin does not diagnose epilepsy. C: It does not predict recurrence. D: It does not determine epilepsy classification. E: Neuroimaging decisions are based on clinical assessment.

Reference: ILAE Commission Report on Prolactin and Seizures; EAN Guidelines