Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures
Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures
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DOI：
10.1111/j.1528-1167.2009.02394.x
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发表时间：
2010-05-01
期刊：
影响因子：
5.6
通讯作者：
Roelofs, Karin
中科院分区：
文献类型：
--
作者：
Bakvis, Patricia;Spinhoven, Philip;Roelofs, Karin
目的：已有研究表明，心因性非癫痫性发作（PNES）与心理创伤有关，但只有少数研究探讨了PNES与神经生物应激系统的关系，如下丘脑-垂体-肾上腺（HPA）轴及其终产物皮质醇。我们测试了几个相关的HPA轴功能与PNES患者和相关的创伤history.Methods：皮质醇觉醒曲线，基础昼夜皮质醇，和负皮质醇反馈（使用1毫克地塞米松抑制试验）进行了检查，在18例PNES和19个匹配的健康对照组（HC）使用唾液皮质醇采样连续两天在19个时间点。伴随交感神经系统（SNS）的活动进行了评估，通过分析唾液α-淀粉酶（sAA）。结果：PNES患者表现出显着增加的基础昼夜皮质醇水平相比，HC。这种影响主要是由报告性创伤的患者驱动的，与没有性创伤报告的患者相比，这些患者表现出更高的皮质醇水平。重要的是，增加患者的基础昼夜皮质醇水平不能解释抑郁症，药物治疗，或吸烟，或由当前的癫痫发作或SNS activity.Discussion组差异：这是第一项研究表明，基础皮质醇增多症患者PNES是独立的急性发作癫痫发作。此外，与非创伤性PNES患者相比，创伤性PNES患者的基础皮质醇增多症更明显。这些结果表明，HPA轴的活动提供了一个重要的神经生物学标记PNES。
P>Purpose: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.Discussion: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.