This is the current release of the guideline.

Definitions of the classification of the recommendations (A, B, C, U) and classification of the evidence (Class I through Class IV) are provided at the end of the "Major Recommendations" field.

Practice recommendations: For clinicians considering a laboratory blood test to diagnose epileptic seizures (ES)

1. Elevated serum prolactin (PRL), when measured in appropriate clinical setting at 10 to 20 minutes after a suspected event, should be considered a useful adjunct to differentiate generalized tonic-clonic seizures or complex partial seizures from psychogenic nonepileptic seizures among adults and older children (Level B).
2. Serum PRL, when measured more than 6 hours after a suspected event, should be representative of the baseline PRL level (Level B).
3. Serum PRL assay is not of utility to distinguish seizure from syncope (Level B).
4. The utility of serum PRL assay has not been established in the evaluation of status epilepticus, repetitive seizures, or neonatal seizures (Level U).

Definitions

Classification of Recommendation

A: Established as effective, ineffective, or harmful for the given condition in the specified population. (Level A rating requires at least two consistent Class I studies.)

B: Probably effective, ineffective, or harmful for the given condition in the specified population. (Level B rating requires at least one Class I study or at least two consistent Class II studies.

C: Possibly effective, ineffective, or harmful for the given condition in the specified population. (Level C rating requires at least one Class II study or two consistent Class III studies.)

U: Data inadequate or conflicting given current knowledge; treatment is unproven.

Classification of Evidence

Class I: Evidence provided by a prospective study in a broad spectrum of persons with the suspected condition, using a reference ("gold") standard for case definition, where a test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy. All patients undergoing the diagnostic test have the presence or absence of the disease determined.

Class II: Evidence provided by a prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by "gold standard") compared with a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy.

Class III: Evidence provided by a retrospective study where either persons with the established condition or controls are of a narrow spectrum, and where the reference standard, if not objective, is applied by someone other than the person who performed the test.

Class IV: Any design where the test is not applied in an independent evaluation or evidence provided by expert opinion alone or in descriptive case series (without controls).

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations" field).

Not applicable: The guideline was not adapted from another source.

2005 Sep

American Academy of Neurology - Medical Specialty Society

American Academy of Neurology (AAN)

Therapeutics and Technology Assessment Subcommittee

Primary Authors: David K. Chen, MD; Yuen T. So, MD, PhD; Robert S. Fisher, MD, PhD

Therapeutics and Technology Assessment Subcommittee Members: Douglas S. Goodin, MD (Chair); Yuen T. So, MD, PhD (Vice-Chair); Carmel Armon, MD, MHS; Richard M. Dubinsky, MD, MPH; Mark Hallett, MD; David Hammond, MD; Cynthia Harden, MD; Chung Hsu, MD, PhD; Andres M. Kanner, MD; David S. Lefkowitz, MD; Janis Miyasaki, MD; Michael A. Sloan, MD, MS; James C. Stevens, MD

The authors report no conflicts of interest.

This is the current release of the guideline.

None available

This summary was completed by ECRI on December 23, 2005.

This NGC summary is based on the original guideline, which is copyrighted by the American Academy of Neurology.