Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures.
OBJECTIVE
Several studies have indicated that psychogenic nonepileptic seizures (PNES) are associated with psychological trauma, but only a few studies have examined the associations with neurobiologic stress systems, such as the hypothalamus-pituitary-adrenal (HPA) axis and its end-product cortisol. We tested several relevant HPA-axis functions in patients with PNES and related them to trauma history.


METHODS
Cortisol awakening curve, basal diurnal cortisol, and negative cortisol feedback (using a 1 mg dexamethasone suppression test) were examined in 18 patients with PNES and 19 matched healthy controls (HCs) using saliva cortisol sampling on two consecutive days at 19 time points. Concomitant sympathetic nervous system (SNS) activity was assessed by analyzing saliva alpha-amylase (sAA).


RESULTS
Patients with PNES showed significantly increased basal diurnal cortisol levels compared to HCs. This effect was driven mainly by patients reporting sexual trauma who showed a trend toward higher cortisol levels as compared to patients without a sexual trauma report. Importantly, the increased basal diurnal cortisol levels in patients were not explained by depression, medication, or smoking, or by current seizures or group differences in SNS activity.


CONCLUSIONS
This is the first study showing that basal hypercortisolism in patients with PNES is independent of the acute occurrence of seizures. In addition, basal hypercortisolism was more pronounced in traumatized patients with PNES as compared to nontraumatized patients with PNES. These findings suggest that HPA-axis activity provides a significant neurobiologic marker for PNES.
Bakvis
Patricia
P
SEIN, Epilepsy Institute in the Netherlands, Heemstede, The Netherlands. pbakvis@sein.nl
Spinhoven
Philip
P
Giltay
Erik J
EJ
Kuyk
Jarl
J
Edelbroek
Peter M
PM
Zitman
Frans G
FG
Roelofs
Karin
K
D000328:Adult; D000367:Age Factors; D015415:Biomarkers; D002940:Circadian Rhythm / Q000502:physiology*; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D003907:Dexamethasone; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D012463:Saliva / Q000737:chemistry*; D055291:Salivary alpha-Amylases / Q000032:analysis; D012640:Seizures / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D012737:Sex Factors; D012742:Sex Offenses / Q000523:psychology / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000503:physiopathology
D015415:Biomarkers; D003907:Dexamethasone; D055291:Salivary alpha-Amylases; D006854:Hydrocortisone