Seizure

Diagnosis

Determining whether a seizure occurred

Physical examination

A small study found that finding a bite to the side of the tongue was very helpful when present"

• sensitivity of 24%
• specificity of 99%

Serum prolactin level

Two meta-analyses have quantified the role of an elevated serum prolactin. The first meta-analysis found that: "If a serum prolactin concentration is greater than three times the baseline when taken within one hour of syncope, then in the absence of test "modifiers":

1. the patient is nine times more likely to have suffered a GTCS as compared with a pseudoseizure positive LR = 8.92 (95% CI (1.31 to 60.91)), SN = 0.62 (95% CI (0.40 to 0.83)), SP = 0.89 (95% CI (0.60 to 0.98))
2. five times more likely to have suffered a GTCS as compared with non-convulsive syncope positive LR 4.60 (95% CI (1.25 to 16.90)), SN = 0.71 (95% CI (0.49 to 0.87)), SP = 0.85 (95% CI (0.55 to 0.98)). "

The second meta-analysis found:

1. "Elevated serum prolactin assay, when measured in the appropriate clinical setting at 10 to 20 minutes after a suspected event, is a useful adjunct for the differentiation of generalized tonic-clonic or complex partial seizure from psychogenic nonepileptic seizure among adults and older children (Level B)."
2. "Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B).
3. "The use of serum PRL assay has not been established in the evaluation of status" epilepticus, repetitive seizures, and neonatal seizures (Level U)."

The serum prolactin level is less sensitive for detecting partial seizures.

EEG

An isolated abnormal electrical activity recorded by an electroencephalography examination without a clinical presentation is called subclinical seizure. They may identify background epileptogenic activity, as well as help identify particular causes of seizures.