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)
- 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).
- Serum PRL, when measured more than 6 hours after a suspected event, should be representative of the baseline PRL level (Level B).
- Serum PRL assay is not of utility to distinguish seizure from syncope (Level B).
- 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).