Prolactin changes during electroconvulsive therapy

Prolactin levels in cerebrospinal fluid of patients with infantile spasms

Infantile spasms are an age-related epileptic syndrome of infancy and are characterized by the combination of clusters of epileptic spasms and specific electroencephalographic findings. The etiology and the pathogenesis of the disease is still unclear. Prolactin has been thought to be specifically related to epileptic seizures. To investigate the possible mechanism of prolactin secretion in infantile spasms cerebrospinal fluid prolactin levels were examined. Fifteen patients with infantile spasms (10 females and five males), 3-16 months of age, were evaluated and compared with age- and sex-matched control subject. Cerebrospinal fluid samples for prolactin were obtained before and after treatment. The mean prolactin levels in the cerebrospinal fluid of the patients before therapy (3.25 +/- 1.48 ng/mL) was higher than the control group (2.38 +/- 0.89 ng/mL), and the difference between the two groups was statistically significant (P < 0.001). The mean prolactin level in the cerebrospinal fluid of the patients after therapy (4.69 +/- 1.47 ng/mL) was demonstrated to be higher than the mean prolactin level before therapy (3.25 +/- 1.48 ng/mL) and the difference between the two groups was statistically significant (P = 0.037). Elevation of cerebrospinal fluid prolactin levels before and after treatment in patients with infantile spasms provided evidence that the cerebrospinal fluid prolactin level is related with neuronal injury.

The effect of seizures and kindling on reproductive hormones in the rat

Reproductive dysfunction and endocrine disorders are common among both women and men with epilepsy, and, in particular, with temporal lobe epilepsy. In clinical studies, it is hard to separate the effects of seizures from the effects of medication and life style. Studies in rodents, however, suggest that seizures per se can contribute to reproductive dysfunction. In female rats, generalized seizures disrupt normal ovarian cyclicity in adults, and repeated electroshock seizures delay the onset of puberty in juveniles. Right amygdala kindling in adult female rats causes acyclicity, the development of polycystic ovaries and premature aging of the hypothalamic-pituitary neuroendocrine axis, leading to chronic anovulation and continuous estrogen exposure. In adult male rats, repeated electroshock seizures result in transient hypogonadism, characterized by decreased serum testosterone levels and lowered gonadal tissue weight. In contrast, right amygdala kindling increases serum testosterone, estradiol levels and gonadal weight. These findings suggest that reproductive dysfunction in women and men with epilepsy may result from recurrent seizure activity, due to seizure-related interference with the normal functions of the hypothalamic-pituitary-gonadal axis.

Gender but not stimulus parameters influence prolactin response to electroconvulsive therapy

The post-ictal prolactin (PRL) response represents one of the most consistent findings of electroconvulsive therapy (ECT), but correlates variably with the gender of the patient, ECT stimulus waveform, dose and electrode placement. Forty patients with endogenous depression (29 drug-naive) received either high-energy (240 mC) or low-energy (60 mC) bilateral brief-pulse ECT once or three times a week. The PRL and growth hormone (GH) levels were estimated using double antibody radioimmunoassay. The average post-ECT PRL levels differed significantly from the pre-ECT levels, with a seven- to nine-fold increase in PRL at each week of treatment. No such difference was observed in the GH levels. All patients showed an increase in PRL levels, whereas 42% failed to show an increase in GH levels. The delta PRL response (difference between post-ECT and pre-ECT serum hormone levels) was not significantly different between the drug-naive and medicated patients nor between the high-energy and low-energy groups at first ECT. Similarly, no difference was observed between the once-weekly and thrice-weekly groups at the third week of ECT. At each week of treatment, the delta PRL was significantly higher in females than in males, unlike the GH response. Electroencephalographic (EEG) seizure duration did not correlate with either delta PRL or delta GH at first ECT and third week ECT. Apart from gender, none of the variables, such as age, baseline severity of illness, presence of psychotic symptoms, drug-naive status, stimulus dose, seizure duration, seizure strength, pattern and symmetry, frequency of ECT and degree of improvement predicted the delta PRL response. Neither stimulus energy nor frequency of ECT had a significant effect on PRL response. Gender differences in PRL response to ECT merit further investigations.

Potential role of serum prolactin measurement in the diagnosis of late posttraumatic seizures. A case report

Posttraumatic seizures are an important medical complication after traumatic brain injury. However, the diverse clinical presentation of posttraumatic seizures, combined with the cognitive and behavior deficits frequently seen in this patient population, can make the diagnosis of posttraumatic seizures particularly challenging. Electroencephalography and imaging studies are often abnormal and nonspecific. It has been reported that serum prolactin levels frequently rise after epileptic seizures. This case report describes the use of prolactin measurement to confirm two suspected posttraumatic seizure episodes in a 42-yr-old male with severe traumatic brain injury. Each episode lasted less than 1 min and involved conspicuously altered postural tone and respiratory pattern, followed by a change in verbal and motor responsiveness. No rhythmic extremity movements were observed. Diagnostic evaluation included electroencephalography and imaging studies, which demonstrated nonspecific abnormalities. Serum prolactin levels obtained within 20 to 40 min were markedly elevated and two to three times greater than the baseline level. The use of prolactin levels in the diagnosis of posttraumatic seizures is reviewed, accompanied by discussion of pertinent aspects of normal and abnormal states of prolactin secretion and regulation.

Effect of ECT treatment number on the ictal EEG

Recent evidence suggests that attributes of the ictal electroencephalogram (EEG) may be clinically useful for estimating the extent to which the electroconvulsive therapy (ECT) stimulus exceeds the seizure threshold (relative stimulus intensity). Such a tool could allow a practitioner, who chose, on the basis of expected therapeutic response and side effect rates, to implement stimulus dosing to maintain relative stimulus intensity over the treatment course, despite the uncertain rise in seizure threshold that occurs. One potential confounding factor is a possible systematic change in the ictal EEG over the treatment course that is not due to changes in seizure threshold. We explored the effect of treatment number by comparing ictal EEG data obtained at treatments across the ECT course that were delivered at the identical relative stimulus intensity. We found that the ictal EEG at treatment 1 was characterized by a greater mid-ictal amplitude and post-ictal suppression (trend) than subsequent treatments for barely suprathreshold unilateral ECT, but not for barely suprathreshold bilateral or moderately suprathreshold unilateral ECT, and that this change may affect therapeutic effectiveness. These findings suggest the importance of treatment-number effects for the clinical application of the ictal EEG and point to possible physiological differences between unilateral and bilateral ECT.

Magnetic brain stimulation: safety studies

We describe short-term and long-term safety studies after low repetition rate magnetic brain stimulation in 10 normal subjects. We obtained quantitative EEG data, psychometric test results, serum prolactin and cortisol levels before and after brain stimulation. EEG and psychometric data were also obtained in 5 of these subjects 16-24 months after the initial experiment. Short- and long-term studies did not show any deleterious effects. Randt delayed recalls, however, showed a transient reduction in the score immediately after stimulation which resolved on retesting in 2 weeks. To address the question of fatigue we repeated Randt tests in 4 subjects before and after magnetic brain stimulation but without the other extensive psychometric, EEG and blood tests. Pre- and post-stimulation scores on this occasion showed no significant difference in these 4 subjects suggesting that the transient changes in the previous Randt score were related to fatigue. We conclude that single-pulse magnetic brain stimulation has no deleterious effects after magnetic brain stimulation.

Transcranial magnetic stimulation. Its role in the evaluation of patients with partial epilepsy

Transcranial magnetic stimulation (TMS) is a relative new method in the evaluation of patients with various neurological diseases. With the introduction of repetitive (rapid rate) transcranial magnetic stimulators (RTMS), it has been possible to apply cortical stimuli with a stimulus rate up to 100 Hz. The preliminary results with TRMS suggest that it may be used in the study of speech lateralization. Seizures have been reported in patients with partial epilepsy during TMS. In these cases it remains uncertain whether the seizures were induced by the TMS or coincidentally with it. Minor changes in paroxysmal activity have been reported in some patients. These data suggest, that TMS is neither sensitive nor specific as an activation procedure of the epileptic focus in patients with partial epilepsy. Seizures have been provoked using RTMS, but its use as a seizure-inducing method is not yet evaluated.

Activation of epileptic foci by transcranial magnetic stimulation: effects on secretion of prolactin and luteinizing hormone

Transient elevation of serum levels of prolactin has been observed following several types of epileptic seizures and after electrical stimulation of limbic temporal lobe structures via implanted electrodes. Transcranial magnetic stimulation has been found to selectively induce epileptiform afterdischarges in the epileptic focus of candidates for epilepsy surgery who suffered from temporal lobe epilepsy. Lateralized serial transcranial magnetic stimulation was therefore used and serum levels of prolactin or luteinizing hormone were measured to find if it could be used as a non-invasive diagnostic tool. The investigation was performed on six patients and five healthy volunteers. In the patients the induction of epileptiform potentials was continuously monitored via subdural electrodes. A transient surge of prolactin and luteinizing hormone was found in only one patient, in whom a complex partial seizure was induced. Thus, transcranial magnetic stimulation appeared not to be helpful for the lateralization of the (primary) epileptic focus during presurgical evaluation.

Intensive neurodiagnostic monitoring in psychiatry

A series of technological advances have made it possible to closely monitor electrophysiological and behavioural manifestations of episodic clinical events over prolonged periods of time, with the ability to review the records at leisure or to submit them to computer analysis. The more promising techniques are time-locked video/EEG monitoring, cable telemetry, radiotelemetry, ambulatory cassette recording, intensive plasma anti-epileptic drug monitoring and continuous neuropsychological monitoring. The greatest promise of these techniques is for the diagnosis, research and management of epilepsy. For psychiatry, they offer additional help in the differential diagnosis of non-epileptic events from epilepsy, the most important of which are psychogenic seizures and episodes of aggression. This paper discusses the potential role of these techniques in the assessment of non-epileptic events and transient cognitive impairment in clinical psychiatry.

Effects of ECT on prolactin, LH, FSH and testosterone in males with major depressive illness

Fourteen males with major depressive illness (DSM-III) received a course of electroconvulsive therapy (ECT). Serum prolactin (PRL), luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone (T), were measured 15 minutes before and 15 minutes after each treatment. The severity of depression was assessed with the Hamilton Rating Scale for Depression (HRSD) two to three days before the first and two to three days following the last treatment. Post-ECT levels of PRL and LH were significantly higher than pre-ECT levels across every treatment. Changes in FSH and testosterone were not significant. There were no relationships between hormone levels (first versus last ECT) and severity of depression, including sexual functioning. It is argued that the relatively greater increases of LH than FSH is due to an acute antidopaminergic action of ECT which acts selectively on the secretion of the former. The blunted testosterone response to the increase of gonadotropins may be due to ECT-induced hyperprolactinemia.

Arginine vasopressin, but not corticotropin releasing factor, is a potent stimulator of adrenocorticotropic hormone following electroconvulsive treatment

Neuroendocrine responses to the hypothalamic pituitary-adrenal axis following electroconvulsive treatment (ECT) were evaluated in twelve depressed (6 males/6 females) patients. Plasma concentrations of arginine vasopressin (AVP), corticotropin releasing factor (CRF), corticotropin (ACTH), and cortisol were measured using radioimmunological methods at four different ECT occasions. At each occasion plasma samples were taken immediately before ECT, at the recovery of spontaneous breathing and at 10 and 30 minutes after the ECT. No changes were observed in the plasma CRF concentrations. A large and rapid increase in plasma AVP concentrations was seen after the ECTs. This was followed by increased plasma ACTH and plasma cortisol levels. It is generally believed that AVP exerts a modulatory potentiating action on the CRF-induced ACTH release. The present results demonstrate that AVP per se can cause a release of ACTH from the anterior pituitary.

Lack of effect of naloxone on prolactin and seizures in electroconvulsive therapy

Both opiate agonist and antagonist injection have been reported to modulate prolactin secretion, alter brain excitability and produce seizures, and modify the postictal state. We studied the effects of administration of high-dose naloxone, an opiate antagonist, on postictal prolactin levels, seizure duration, and postictal behavior, using patients undergoing electroconvulsive therapy (ECT) as a seizure model. Seven patients had 8 mg naloxone injected prior to one ECT treatment and saline injected prior to another treatment, with the order of injection randomized. Before ECT and 15 min after ECT, prolactin levels were drawn, and no blunting of the expected postictal prolactin elevation by naloxone injection was observed. We found no evidence that endogenous opiates trigger prolactin secretion during seizures. Seizure duration was also similar in saline and naloxone groups, and naloxone did not reverse postictal depression, as has been reported in an animal model.

Prolactin in patients with major depressive disorder and in healthy subjects. I. Cross-sectional study of basal and post-TRH and postdexamethasone prolactin levels

Prolactin (PRL) levels were investigated in patients with major depressive illness and in healthy subjects. Basal and postdexamethasone levels were measured in 27 patients, and levels after thyrotropin-releasing hormone (TRH) stimulation (delta PRL) were measured in 22 patients. Basal and delta PRL were also determined in 64 age- and sex-matched healthy subjects. Both basal and postdexamethasone PRL levels were normal in depressed patients, with the postdexamethasone levels in particular showing no correlation to postdexamethasone cortisol concentrations. One milligram oral dexamethasone did not influence 4:00 PM PRL levels in 15 healthy subjects. delta PRL was significantly elevated in both male and female patients. These increases were not correlated with severity of illness and are difficult to interpret owing to the complexity of the PRL regulatory system. No significant correlations were found between basal or post-TRH PRL and cortisol, thyroid-stimulating hormone (TSH), thyroid hormones, gonadotropins, or estradiol in the patients. However, surprisingly significant positive correlations between basal PRL and basal cortisol, T4 and reverse T3 occurred in healthy subjects. It is as yet unclear how this finding can be explained and what relevance it has. Women tended to have higher basal PRL concentrations than men, but the difference was not significant in either group. delta PRL was significantly higher in women than in men in both patients and controls. No significant influence of age was found.

Naloxone has no effect on hormonal responses to ECT in man

Although there is clear evidence in other species that electroconvulsive therapy (ECT) is associated with changes in endogenous opioid activity, there are few data available for such a role in man. Since ECT leads to changes in certain hormones in man, particularly serum prolactin, it was postulated that such changes may represent an increase in endogenous opioids. Six unmedicated patients with major depressive illness were therefore administered either 4 mg i.v. of the opiate antagonist naloxone or a saline control infusion, just before successive treatments with ECT, in a double-blind, randomized crossover design. Blood was sampled at intervals for serum prolactin, growth hormone (GH), and cortisol. ECT led to a clear rise in serum prolactin, with no significant change seen in either serum GH or serum cortisol during the 20-min sampling interval. Naloxone had no significant effect on any of these changes. It is concluded that the rise in serum prolactin in response to ECT is not mediated by changes in endogenous opioid peptide activity.

Selective effects of ECT on hypothalamic-pituitary activity

The hypothesis that ECT produces selective effects on hypothalamic-pituitary activity was investigated by determining the effect of ECT on pituitary hormone release in nine depressed patients. After ECT there were massive and rapid increases in the plasma concentrations of nicotine- and oestrogen-stimulated neurophysin (NSN and ESN), prolactin (PRL) and adrenocorticotropin (ACTH), smaller increases in plasma luteinizing hormone (LH) and cortisol, a significant decrease in plasma growth hormone (GH) concentration but no change in plasma thyrotropin (TSH). There was significant attenuation of PRL responses with repeated ECT. The hormonal responses to ECT cannot simply be attributed to stress, since a similar pattern of increases in plasma hormone concentrations did not occur in psychologically normal patients in whom plasma hormone concentrations were measured during induction of anaesthesia and abdominal incision for cholecystectomy. Analysis of these hormonal responses in terms of the knowledge available on the neurotransmitter control of pituitary hormone release suggests that some of these hormonal responses to ECT may be mediated by the activation of serotonergic neurones, while others are probably due to direct stimulation of the neuroendocrine neurones themselves.

The effect of acute and repeated electroconvulsive treatment on plasma beta-endorphin, growth hormone, prolactin and cortisol secretion in depressed patients

The effects of single and repeated electroconvulsive treatment (ECT) on beta-endorphin (beta-EP), cortisol, growth hormone (GH) and prolactin (Prl) plasma levels were investigated in nine depressed patients. Blood samples were monitored a day before ECT, the day of the first and sixth ECT (0, 30, 60 and 90 min after seizures), the day afterwards and 4 weeks after termination of the ECT course. A significant elevation of beta-EP levels was achieved immediately with and 24 h after the first and the sixth ECT. A transient increase in basal beta-EP was observed 1 day following the sixth ECT in comparison with pre-treatment level. Peak and 30 min levels of cortisol were increased compared with baseline by the first ECT. The former (peak) but not the latter (30 min) were increased also at the sixth treatment. GH levels were decreased the day after the first ECT in comparison with the pre-treatment levels and immediately following each ECT in comparison with baseline. A trend toward elevation of Prl was observed immediately after the first and sixth ECT, although the rise did not reach significant levels. ECT administration stimulated beta-EP and cortisol secretion and suppressed human GH release, possibly by activation of endorphinergic and/or serotonergic systems. These mechanisms might be involved in the beneficial effect of ECT in depression.

Neuroendocrine effects of limbic activation by electrical, spontaneous, and pharmacological modes: relevance to the pathophysiology of affective dysregulation in psychiatric disorders

1. Literature is reviewed that implicates various limbic structures (particularly amygdala and hippocampus) in the modulation of stress-associated neuroendocrine systems. 2. Procaine and related local anesthetics may show a selective proclivity for activating limbic structures. 3. Procaine stimulates ACTH-cortisol and prolactin, but not growth hormone secretion. This pattern is most comparable to that elicited by stimuli which act bilaterally on temporal lobe and limbic areas. 4. Procaine may be a useful agent for helping to elucidate the anatomic and physiologic basis for mood, endocrine, and cognitive dysregulation associated with stress and affective disorders. 5. The endocrine concomitants of limbic activation may have relevance to the course and symptom complex of affective disorders and related psychiatric conditions.

Prolactin in partial epilepsy: an indicator of limbic seizures

A study was performed to evaluate changes in serum prolactin levels after simple and complex partial seizures, and to identify which specific anatomical structures must be involved in seizures for postictal elevation of prolactin levels to occur. Seventy-eight seizures were studied in patients with electrodes implanted bilaterally into amygdala, hippocampus, hippocampal gyrus, and frontal sites. All 38 complex partial seizures had bilateral limbic ictal discharges, and each was followed by a significant increase in prolactin concentration (mean peak, 50.8 ng/ml; range, 16.0 to 150.0 ng/ml). Eight of 10 simple partial seizures with unilateral high-frequency regional limbic discharges were followed by prolactin elevation (mean peak, 28.2 ng/ml; range, 13.4 to 44 ng/ml). Thirty simple partial seizures with other ictal limbic discharges or without limbic discharges were not followed by an elevated prolactin level. The data indicate that serum prolactin levels always rise after complex partial seizures involving the temporal lobes, and rise after certain simple partial seizures involving limbic structures. Thus, measurement of the prolactin level can help identify which simple partial seizures involve mesial temporal lobe structures. Limbic structures serve to trigger prolactin release, which may depend upon spread of the seizure to subcortical structures.

Effect of interictal epileptiform discharges on nocturnal plasma prolactin concentrations in epileptic patients with complex partial seizures

To investigate the effect of interictal epileptiform discharges (IEDs) on plasma prolactin (PRL) level, we studied 18 epileptic patients with complex partial seizures (CPS) who did not experience clinical or subclinical ictal events during all-night monitoring with polygraphic recording and video imaging. The density of IEDs peaked during non-REM stages and was significantly reduced during REM stage. Mean plasma PRL concentrations in epileptic patients, when sampled at 30-min intervals, showed a moderate but significant elevation during non-REM (p less than 0.001) and awake stages (p less than 0.005), but not during REM stage, when compared with 10 nonepileptic control subjects studied in a similar fashion. The data obtained in this physiologically controlled environment indicate that the cumulative effect of IEDs may modify PRL regulatory mechanisms, resulting in a modest elevation of plasma concentrations independent of ictal discharges.

EEG and serum prolactin studies in relation to transcutaneous stimulation of central motor pathways

Eight adult volunteers had EEG recordings and serial serum prolactin estimations performed both before and after a session of transcutaneous stimulation of the central motor pathways using the technique of Merton and Morton. No significant changes in either the EEG traces or in the serum prolactin values were detected.

The effect on plasma prolactin levels of interictal epileptiform EEG activity

Because of the known effects of seizures on plasma prolactin, the plasma prolactin levels were measured before and after generalised interictal epileptiform activity was provoked in the EEG in five epileptic patients. The findings were compared with those obtained in five normal subjects and three epileptic patients who were also exposed to flicker stimulation, but who did not develop a photoconvulsive EEG response. There was no significant difference in baseline prolactin values, and levels did not change with photic stimulation or in response to the presence of generalised epileptiform activity in the EEG.

Prolactin and thyrotropin in serum during electroconvulsive therapy in patients with major depressive illness

Thirty-three patients with major depressive illness received electroconvulsive therapy (ECT), and serum prolactin (PRL) and thyrotropin (TSH) levels were measured 30 min before and 1, 5, 15, 30, and 60 min after the treatment. There was a threefold increase in PRL levels with a maximum after 15 min. The TSH plasma levels rose significantly with a maximum at 30 min after ECT. No change in PRL and TSH concentrations was seen in control experiments when the patients received anaesthesia only. In 15 patients the hormone levels were studied both during the first and sixth (last) ECT. The PRL and TSH levels were significantly higher following the first as compared to the sixth ECT. Patients on phenothiazines had higher PRL and lower TSH levels than those on other drugs or without medication, but there was no significant difference in the mean increment by ECT. Dopamine depresses PRL and TSH secretion. The diminished hormone release after a series of ECT may be explained by ECT-induced increase of postsynaptic dopamine receptor function leading to inhibition of PRL and TSH release from the pituitary gland.

Prolactin and seizure activity

Prolactin secretion after tonic-clonic seizures (10 patients), complex partial seizures (five) and non-epileptic attacks (three) was studied in a group of children aged between 0.3 and 14 years. Seven patients with other subcategories of seizure disorders were also studied. Eight children with tonic-clonic seizures exhibited post ictal concentrations of prolactin greater than 500 mU/l. One of the children, who responded on one occasion, did not do so on another. Three children with complex partial seizures had post ictal prolactin concentrations greater than 500 mU/l, while in two the increased values were more modest (390 mU/l and 420 mU/l). The timing of the peak post ictal prolactin concentration varied from less than 20 minutes to a prolonged plateau for three hours. Other seizure types--simple partial with motor signs (2), absence seizure (1), myoclonic seizure (1), minor epileptic status (3) (with one exception), and non-epileptic attacks (3) were not associated with post ictal concentrations greater than 500 mU/l.

Serum prolactin and cortisol levels in evaluation of pseudoepileptic seizures

In 6 patients with epilepsy, a twofold increase in serum prolactin levels followed true epileptic seizures, but no significant change followed pseudoepileptic attacks in 6 other patients. Serum prolactin concentration is a useful biochemical marker to distinguish between epileptic and pseudoepileptic seizures. Serum cortisol levels also increased after epileptic seizures, but diurnal and individual variations render the cortisol level a less reliable indicator of such attacks.

Hormone response to repeated electroconvulsive therapy: effects of naloxone

Plasma prolactin (PRL), cortisol, and growth hormone (GH) were measured before, and at 15-min intervals for 1 hr after, electroconvulsive therapy (ECT). This was repeated over a series of 6 consecutive treatments for each of 12 depressed drug-free inpatients. Patients received naloxone, 2 mg or 20 mg, by intravenous infusion before the third and fifth treatment. ECT was consistently followed by a release of PRL and cortisol, although two patterns of PRL response could be distinguished. In eight patients, the PRL response did not change significantly with repeated ECT, whereas in four patients, the plasma PRL increased tenfold after the first treatment and decreased after each successive treatment. The GH level varied widely, with no evidence of a reliable response to ECT. Opiate receptor blockade with low- or high-dose naloxone did not alter the release of PRL or cortisol after ECT. These findings demonstrate a reliable PRL and cortisol response to ECT, but do not support a role for endogenous opiates in these hormonal changes.

Differential effects of flurothyl- and electro-convulsive shock on sexual maturation and prolactin release in the rat

The effects of single and repeated seizures on luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin secretion and on the onset of sexual maturation in rats are described. In addition, the influence of convulsions generated electrically (electroconvulsive shock, ECS) and chemically (using flurothyl) are compared. Repeated flurothyl convulsions and ECS (one daily convulsion from age 24 days) significantly delay vaginal opening in female rats. The incidence of first ovulation at maturation is reduced to 20% compared with 70-100% for untreated groups. Body and adrenal weights in immature rats are not modified by flurothyl convulsions. Repeated ECS does not influence adrenal weight although somatic growth is inhibited. In an effort to clarify the mechanism of action of convulsions on puberty onset, we examined acute changes in LH, FSH and prolactin secretion and the surge response of LH/FSH to gonadal steroid priming. A single flurothyl convulsion potently inhibits prolactin secretion. In contrast, an ECS acutely stimulates prolactin release in male and female rats. Convulsive seizures do not consistently alter tonic gonadotropin output. However, both flurothyl convulsions and ECS attenuate estradiol benzoate/progesterone-induced LH and FSH surges in ovariectomized rats though this is apparently not mediated by dopamine/prolactin since bromocriptine treatment delays sexual maturation without preventing ovulation at first estrus. Similarly, bromocriptine does not disrupt LH/FSH surges induced by gonadal steroid treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocrine function following complex partial seizures

Previous studies have demonstrated hyperprolactinemia following generalized tonic-clonic seizures and after electroconvulsive therapy. We found transient hyperprolactinemia following complex partial seizures but little change in serum gonadotropins, thyroid-stimulating hormone, growth hormone, or cortisol. Serum prolactin was invariably normal interictally. Postictal elevation of serum prolactin may represent a biochemical marker of complex partial seizures, and it offers a potential pathogenic mechanism for the sexual dysfunction that often complicates temporal lobe epilepsy.

Prolactin and gonadotrophin changes following generalised and partial seizures

Postictal values of prolactin, LH and FSH have been recorded in patients with both generalised tonic-clonic and partial seizures. Elevations of prolactin and LH were seen immediately and at 20 minutes in males and females with generalised attacks. At sixty minutes values for prolactin had fallen to baseline levels, but LH remained elevated. FSH values were increased in females only, at twenty and sixty minutes. Following partial seizures prolactin was elevated, especially with complex partial seizures, at twenty minutes. These results are discussed in the light of known electrophysiological mechanisms relating to partial seizures, and clinical guidelines for the use of neurohormonal tests in the evaluation of seizures are suggested.

Immediate increases in plasma prolactin and neurophysin but not other hormones after electroconvulsive therapy

Plasma prolactin, growth hormone, cortisol, luteinising-hormone-releasing hormone (LHRH), thyrotropin-releasing hormone (TRH), and nicotine and oestrogen stimulated neurophysin (NSN and ESN) were measured before and for 6 min after electroconvulsive therapy (ECT) in eight women with severe electroconvulsive therapy (ECT) in eight women with severe depression. Plasma concentrations of NSN and ESN had increased significantly (as much as 10-fold for NSN) within 1 min of the seizure, and concentrations of prolactin had increased within 2-4 min after the seizure. Whereas plasma prolactin and ESN either continued to increase or remained raised throughout the 6 min after seizure, the concentrations of NSN fell to reach a value at 6 min that was approximately 50% of the maximum. There were no increases in any of the other hormones or peptides within the 6 min period under study. Thus ECT has selective effects on hormone release which cannot be attributed simply to a generalised release of pituitary or hypothalamic hormones in response to brain stimulation and/or stress.

Hypophysectomy does not prevent the enhanced monoamine-mediated behavioural responses following repeated electroconvulsive shocks

Groups of hypophysectomised rats were given either an electroconvulsive shock (ECS; 125V, 1 sec) once daily for 10 days or a sham-shock. Twenty-four hours after the final treatment both groups were tested for their responses to the dopamine agonist, apomorphine, the 5-hydroxytryptamine agonist, quipazine, and the alpha 2-adrenoceptor agonist, clonidine. Repeated electroconvulsive shock enhanced the locomotor activity produced by either quipazine (25 mg/kg i.p.) or apomorphine (0.2 mg/kg s.c.) compared to sham-shocked controls. This treatment also attenuated the hypoactivity produced by clonidine (0.5 mg/kg i.p.). These changes are identical to those produced in normal rats by repeated electroconvulsive shock. Hypophysectomy, therefore, did not abolish the increased 5-hydroxytryptaminergic and dopaminergic behavioural responses neither did it prevent the decreased functional activity of central alpha 2-adrenoceptors, which may be presynaptic. These data suggest that although electroconvulsive shock has been reported to stimulate the secretion of various pituitary hormones, this process is not essential for the development of the enhanced monoamine-mediated behavioural responses studied.

Factors influencing prolactin release induced by electroconvulsive therapy

Electroconvulsions have been reported to induce rapid elevations of serum prolactin (PRL) levels. To further evaluate factors involved in the hormonal release an extended study was performed. Blood samples for determination of PRL were withdrawn from depressed patients 5 min before and 15 min after administration of electroconvulsions. Significant elevations of PRL levels were found in 35 of 37 patients. Increase in PRl levels was significantly correlated to duration of seizures but not to duration of the electric stimulation. The hormonal response to electroconvulsions was diminished with age. Patients on lithium medication had significantly more pronounced rises of PRL levels than patients treated with other psychotropic drugs and otherwise untreated patients. The results indicate that the elevation in PRL levels is a biochemical marker of the seizure activity during electroconvulsive therapy.

A theory of convulsive therapy in endogenous depression: significance of hypothalamic functions

The repeated induction of seizures (convulsive therapy) relieves the symptoms of severe depressive mood disorders, particularly those accompanied by vegetative symptoms. Neuroendocrine abnormalities characterize patients with endogenous depression, and the abnormalities are reversed by convulsive therapy. Tests of neuroendocrine functions provide criteria for the classification of such cases, and probably will be useful in defining suitable cases for convulsive therapy. We postulate that the antidepressant efficacy of convulsive therapy results from the increased release and more widespread cerebral distribution of hypothalamic peptides with behavioral effects. Such a hypothesis provides a basis for clinical trials of centrally active peptides in cases of endogenous depression, and for studies of neuroendocrine functions as predictors of outcome in convulsive therapy.

Studies on the prolactin response induced by electroconvulsive therapy in schizophrenics

Electroconvulsive therapy (ECT) and simulated ECT (SECT)-induced prolactin response has been studied in 14 schizophrenic males. Cortisol, growth hormone, and thyroid stimulating hormone (TSH) changes have been measured simultaneously. The prolactin rise was significantly higher after ECT than after SECT. Cortisol increase after ECT did not exceed significantly the elevation after SECT. Changes in growth hormone and TSH concentrations were inconsistent and non-significant. On the basis of the results it may be assumed that ECT-induced prolactin response is a consequence of specific transmitter changes in the CNS and not a result of stress reaction or generalized neuronal discharge. ECT-induced prolactin response was negligible in two cases. Both patients were chronically hospitalized schizophrenics resistant to therapy. Whether the prolactin response or its absence is of predictive value with respect to prognosis or effect of ECT remains to be seen.

Endocrine factors and glucose metabolism during prolonged seizures in baboons

Changes in plasma glucose, nonesterified fatty acids, insulin, glucagon, cortisol, growth hormone, and prolactin have been studied in baboons during the course of generalized epileptic seizures induced by intravenous bicuculline. Plasma glucose rose to a peak at 25 min but fell to hypoglycemic levels after 60 min of seizure activity. This hypoglycemia was accompanied by a marked elevation in plasma insulin. Plasma glucagon rose to a peak at 14 min, then returned to normal. Plasma growth hormone levels were elevated after 60 min of seizure activity. Plasma prolactin and cortisol levels also rose during the seizure. These changes result from sequential interaction of (1) autonomic activation at seizure onset, (2) spread of neuronal activity to the hypothalamus leading to the liberation of releasing factors, and (3) indirect physiologic consequences of seizure activity.