title: Impairment of inhibitory control of the hypothalamic pituitary adrenocortical system in epilepsy.
abstract: Excess comorbidity between depression and epilepsy proposes common pathophysiological patterns in both disorders. Neuroendocrine abnormalities were often observed in depression as well as in epilepsy. Lack of inhibitory control of the hypothalamic pituitary adrenocortical (HPA) system is a core feature of depression; main relay stations of this system are located in the amygdala and hippocampus, which are key regions for both disorders. Therefore we explored the feedback mechanism of the HPA system in epilepsy. In order to control for the impact of depression we focused on epilepsies without depression. We compared patients with epilepsy (subdivided by medication with or without hepatic enzyme inducing antiepileptic medication) with 16 healthy controls and 16 patients with unipolar major depression but without epilepsy. We observed a lack of inhibitory control of the HPA system in patients with epilepsy, also in the absence of enzyme inducing medication. An impact of the temporal lobe location of the epileptic focus could not be observed. Thus, epilepsies share with depression the deficiencies in the feedback mechanism of the HPA system, proposing common pathophysiological features of up to now unknown nature.
authors.affiliation: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. astrid.zobel@ukb.uni-bonn.de
authors.forename: Astrid
authors.initials: A
authors.lastname: Zobel
authors.forename: Jörg
authors.initials: J
authors.lastname: Wellmer
authors.forename: Svenja
authors.initials: S
authors.lastname: Schulze-Rauschenbach
authors.forename: Ute
authors.initials: U
authors.lastname: Pfeiffer
authors.forename: Susanne
authors.initials: S
authors.lastname: Schnell
authors.forename: Christian
authors.initials: C
authors.lastname: Elger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000627:therapeutic use; D019540:Area Under Curve; D003863:Depression / Q000378:metabolism / Q000503:physiopathology*; D003907:Dexamethasone / Q000008:administration & dosage / Q000097:blood; D004827:Epilepsy / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology*; D025461:Feedback, Physiological / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D013058:Mass Spectrometry / Q000379:methods; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology*; D011863:Radioimmunoassay; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone