Serum prolactin and creatine kinase levels in epileptic and non-epileptic seizures

ABSTRACT

The adverse effects of anticonvulsant drugs, duration and expense of therapy and social implications, make it essential for accurate diagnosis before starting treatment. Many patients being treated as epileptics are not actually so. Moreover the coexistence of pseudoseizures with epilepsy is high. There is no single exposure, biochemical marker to differentiate between epileptic and non epileptic seizures [NES]. Ninety children were studied. They were subgrouped into 4 groups. Group I included 30 children with recent epileptic fits, aged 2-12 years. Group II consisted of 15 children with recent typical febrile seizures, aged 1-4.75 years. Group III involved 15 children with recent non-epileptic seizures, aged 5.2-12.7 years. Thirty clinically healthy children aged 3-12 years represented group IV [control group]. Thorough history and clinical examination confirmed diagnosis and established exclusion criteria. CT brain, EEG and EMG imaging studies were done for all patients. Peripheral white blood cell count [WBCs], serum creatine kinase [CK] and prolactin levels were measured within lapse time [15-120 minutes] and 24 hrs post-ictally for all patients and once for control children. Post-ictal symptoms were present in more than 2/3 of epileptic seizures and 20% only of non-epileptic fits. WBCs and serum prolactin levels showed a transient early; while serum CK levels had a late post-ictal significant increase after generalized epileptic fits and to a much lower extent following focal and nonepileptic fits. The generalized tonic-clonic seizures [GTCS] showed higher elevation than other types of generalized epileptic fits. The three parameters showed a positive correlation with duration of seizures and a negative correlation with lapse time. Peripheral WBCs and serum prolactin returned to near normal levels one day post-ictally, while serum CK started to show a significant increase only 24 hrs after seizures. Serum prolactin levels were elevated more than twice and serum CK levels increased by more than 20 U/L in a high percentage of epileptic GTC seizures. The integrated interpretation of post-ictal symptoms, early assessment of peripheral WBCs and serum prolactin [<2 hrs] and late measurement of serum CK levels [>24 hrs] can compensate for our clinical uncertainty between epileptic and non-epileptic seizures before having to resort to more sophisticated and expensive investigations