title: Cortisol fluctuations relate to interictal epileptiform discharges in stress sensitive epilepsy.
abstract: People with epilepsy often report seizures precipitated by stress. This is believed to be due to effects of stress hormones, such as cortisol, on neuronal excitability. Cortisol, regardless of stress, is released in hourly pulses, whose effect on epileptic activity is unknown. We tested the relation between cortisol levels and the incidence of epileptiform abnormalities in the electroencephalogram of people with focal epilepsy. Morning cortisol levels were measured in saliva samples obtained every 15 min. Interictal epileptiform discharges were determined in the same time periods. We investigated the relationship between cortisol levels and the epileptiform discharges distinguishing persons with from those without stress-precipitated seizures (linear mixed model), and analysed the contribution of individual, epilepsy and recording characteristics with multivariable analysis. Twenty-nine recordings were performed in 21 individuals. Cortisol was positively related to incidence of epileptiform discharges (β = 0.26, P = 0.002) in people reporting stress-sensitive seizures, but not those who did not report stress sensitivity (β = -0.07, P = 0.64). The relationship between cortisol and epileptiform discharges was positively associated only with stress sensitivity of seizures (β = 0.31, P = 0.005). The relationship between cortisol levels and incidence of interictal epileptiform discharges in people with stress-sensitive seizures suggests that stress hormones influence disease activity in epilepsy, also under basal conditions.
authors.affiliation: 1 Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands 2 Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands J.S.vanCampen@gmail.com.
authors.forename: Jolien S
authors.initials: JS
authors.lastname: van Campen
authors.affiliation: 3 Department of Clinical Neurophysiology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: E Lorraine
authors.initials: EL
authors.lastname: Hompe
authors.affiliation: 1 Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: Floor E
authors.initials: FE
authors.lastname: Jansen
authors.affiliation: 4 Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands 5 Department of Neurosurgery, Free University Medical Center Amsterdam (VUmc), The Netherlands.
authors.forename: Demetrios N
authors.initials: DN
authors.lastname: Velis
authors.affiliation: 1 Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands 6 Biomedical MR Imaging and Spectroscopy Group, Image Sciences Institute, University Medical Center Utrecht, The Netherlands.
authors.forename: Willem M
authors.initials: WM
authors.lastname: Otte
authors.affiliation: 4 Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
authors.forename: Fia
authors.initials: F
authors.lastname: van de Berg
authors.affiliation: 1 Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: Kees P J
authors.initials: KP
authors.lastname: Braun
authors.affiliation: 4 Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
authors.forename: Gerhard H
authors.initials: GH
authors.lastname: Visser
authors.affiliation: 4 Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands 7 NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
authors.affiliation: 2 Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: Marian
authors.initials: M
authors.lastname: Joels
authors.affiliation: 3 Department of Clinical Neurophysiology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands 4 Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
authors.forename: Maeike
authors.initials: M
authors.lastname: Zijlmans
mesh_terms: D000328:Adult; D000368:Aged; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000378:metabolism; D013315:Stress, Psychological / Q000150:complications / Q000378:metabolism*; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: EEG; HPA-axis; seizures; spikes; ultradian