1. A 24 year old girl is brought to the hospital with history of her hands and legs twitching uncontrollably. Her boyfriend says that he had a fight with her 2 days back and after that he moved out of the apartment in which they were living together. That morning when he went to make up with her, she developed this kind of violent movement when he entered her room. The ER physician is doubtful if this is a true seizure disorder or a non epileptic seizure (psychogenic). He orders a serum prolactin test. Which of the following statements about serum prolactin in this scenario is true?
   
1. Serum Prolactin rises shortly after the seizure episode so it is very useful in this case.
2. The serum prolactin in this patient is not useful, as it was not a generalized tonic clonic seizure.
3. The serum prolactin test should be used in this patient, as the reason for her seizure might be a prolactin secreting pituitary adenoma.
4. Raised Serum prolactin is not useful in distinguishing between epileptic and non epileptic seizures.

Answer: The correct answer is (d). Serum prolactin concentrations may rise shortly after generalized tonic-clonic seizures and some partial seizures, compared with baseline. However, serum prolactin assessment is not useful as a diagnostic test for epileptic seizures because prolactin may not rise after the last in a cluster of seizures (including tonic-clonic seizures) closely spaced in time or following a single partial seizure. In addition, prolactin assessment is not useful for distinguishing epileptic from nonepileptic seizures, since prolactin may rise following a nonepileptic seizure.

On the other hand, if the prolactin level is normal, it may be helpful in pointing towards psychogenic seizures.
Although statements a and d are similar, d is true to a greater extent.