Prolactin levels in sudden unexpected death in epilepsy

Purpose: To assess serum prolactin levels in sudden unexpected death in epi lepsy (SUDEP) and control groups to test the hypothesis that if seizures oc cur routinely as a terminal event in SUDEP, then raised prolactin levels ma y be an indicator of terminal seizure. Methods: Blood was taken for measurement of prolactin levels from subjects with SUDEP and three control groups. The control groups were those with epi lepsy dying from causes other than epilepsy (e.g., ischemic heart disease o r injuries), physiologically stressed individuals without epilepsy (they we re admitted to the hospital after an acute illness and died after several h ours to 3 days). and nonepileptic rapid deaths (these people collapsed sudd enly and died at the scene). In the SUDEP group, evidence for terminal seiz ure was considered to be at least one of the following: body found half on, half off the bed, or urinary incontinence at the scene, or bitten lips or tongue at autopsy. Results: There was evidence for terminal seizure at the scene or at autopsy in four of the 10 SUDEP cases. Serum prolactin levels were not significant ly increased in the SUDEP group compared with the controls. None of the SUD EP subjects, including those with clinical evidence of a terminal seizure, had high prolactin levels characteristic of those observed after seizures i n living subjects. Conclusions: Prolactin levels are not raised in SUDEP, even if there is evi dence of terminal seizure. As prolactin takes 15-20 min to peak after a sei zure in life, there may be insufficient time for a prolactin increase to oc cur in SUDEP. Thus prolactin levels cannot be used to determine if a deceas ed individual with epilepsy had a seizure or to answer the broad question w hether SUDEP is always associated with a terminal seizure.