title: Hypothalamic-pituitary-adrenocortical axis dysfunction in epilepsy.
abstract: Epilepsy is a common neurological disease, affecting 2.4million people in the US. Among the many different forms of the disease, temporal lobe epilepsy (TLE) is one of the most frequent in adults. Recent studies indicate the presence of a hyperactive hypothalamopituitary- adrenocortical (HPA) axis and elevated levels of glucocorticoids in TLE patients. Moreover, in these patients, stress is a commonly reported trigger of seizures, and stress-related psychopathologies, including depression and anxiety, are highly prevalent. Elevated glucocorticoids have been implicated in the development of stress-related psychopathologies. Similarly, excess glucocorticoids have been found to increase neuronal excitability, epileptiform activity and seizure susceptibility. Thus, patients with TLE may generate abnormal stress responses that both facilitate ictal discharges and increase vulnerability for the development of comorbid psychopathologies. Here, we will examine the evidence that the HPA axis is disrupted in TLE, consider potential mechanisms by which this might occur, and discuss the implications of HPA dysfunction for seizuretriggering and psychiatric comorbidities.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH, United States; Neuroscience Program, University of Cincinnati, College of Medicine, Cincinnati, OH, United States; Department of Anesthesia, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States. Electronic address: wulsinac@mail.uc.edu.
authors.forename: Aynara C
authors.initials: AC
authors.lastname: Wulsin
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH, United States; Neuroscience Program, University of Cincinnati, College of Medicine, Cincinnati, OH, United States.
authors.forename: Matia B
authors.initials: MB
authors.lastname: Solomon
authors.affiliation: Department of Neurology, Neuroscience Institute, University of Cincinnati, Cincinnati, OH, United States.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Privitera
authors.affiliation: Neuroscience Program, University of Cincinnati, College of Medicine, Cincinnati, OH, United States; Department of Anesthesia, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Steve C
authors.initials: SC
authors.lastname: Danzer
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH, United States; Neuroscience Program, University of Cincinnati, College of Medicine, Cincinnati, OH, United States. Electronic address: james.herman@uc.edu.
authors.forename: James P
authors.initials: JP
authors.lastname: Herman
mesh_terms: D004700:Endocrine System Diseases / Q000453:epidemiology / Q000209:etiology*; D004827:Epilepsy / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*
keywords: CRH; Glucocorticoids; Psychopathologies; Stress; Temporal lobe epilepsy