AAN Releases Guidelines for the Use of Serum Prolactin Assays in Diagnosing Epileptic Seizures

The recent accessibility of video electroencephalography (EEG) monitoring has reduced interest in the use of prolactin in distinguishing epileptic seizures from psychogenic nonepileptic seizures. However, a serum marker continues to be clinically useful when video EEG is not available. The American Academy of Neurology (AAN) has released evidence-based recommendations for the use of serum prolactin tests in differentiating between epileptic and nonepileptic seizures. The report was published in the September 2005 issue of Neurology.

The AAN developed the following practice recommendations for physicians considering a laboratory blood test to diagnose epileptic seizures:

• When measured in appropriate clinical settings at 10 to 20 minutes after a suspected event, elevated serum prolactin levels are useful in distinguishing generalized tonic-clonic seizures or complex partial seizures from psychogenic nonepileptic seizures in adults and older children.

• Serum prolactin levels should be representative of the baseline prolactin level when measured more than six hours after a suspected episode.

• Serum prolactin assay is not useful in distinguishing seizure from syncope.

• Serum prolactin assay has not been established in the assessment of status epilepticus, repetitive seizures, or neonatal seizures.

The AAN also made the following recommendations for future research on serum prolactin assays:

• Additional research should be done to provide a more accurate standardization of sex-specific prolactin threshold values.

• Studies should evaluate the usefulness of an out-patient prolactin kit that could be kept in the patient’s home to document capillary prolactin changes shortly after seizure episodes.

• Studies should determine what prolactin changes occur after other seizure imitators that may affect the hypothalamic-pituitary axis (e.g., migraines, transient ischemic attacks, cardiac arrhythmias).

• Prospective studies of postictal prolactin measures in neonates and young children are needed.

• Additional data are needed to interpret prolactin values after status epilepticus and repetitive seizures.

CDC Reports on Trends in Cholesterol Screening and Awareness

The Centers for Disease Control and Prevention (CDC) has published a report on the prevalence of cholesterol screening and awareness using data from the Behavioral Risk Factor Surveillance System. The findings were published in the September 9, 2005, issue of Morbidity and Mortality Weekly Report and are available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5435a2.htm.

Between 1991 and 2003, the prevalence of cholesterol screening in the preceding five years and the percentage of patients who were told that they had high blood cholesterol levels (i.e., 240 mg per dL [6.2 mmol per L] or greater) increased among all age, sex, racial, and ethnic groups. In 1991, 25.3 percent of persons who had cholesterol screenings within the preceding five years were told that they had high blood cholesterol levels (95% confidence interval [CI], 24.7 to 25.8). In 2003, that percentage had increased to 31.1 percent (95% CI, 30.7 to 31.5). Reporting of high blood cholesterol levels increased among all age groups, with the largest percentage change among persons 65 years or older.

In 2003, the prevalence of cholesterol screenings was found to be lowest among Hispanics (65.5 percent; 95% CI, 64.1 to 67.0) and Asians/Pacific islanders (69.6 percent; 95% CI, 66.9 to 72.4). The largest percentage changes were among American Indians/Alaskan Natives and non-Hispanic blacks. Overall, the greatest increase occurred in Hispanics. The data also show that, overall, women were more likely than men to have a cholesterol screening within the preceding five years.