Cortisol Fluctuations Relate to Interictal Epileptiform Discharges in Stress Sensitive Epilepsy

Half of all individuals with epilepsy report stress-precipitated seizures. Van Campen et al. reveal a positive relation between non-stress-related ultradian cortisol fluctuations and interictal epileptiform discharges, which is seen only in those with stress-sensitive seizures. This suggests that stress hormones can influence disease activity in epilepsy, also under basal conditions.Half of all individuals with epilepsy report stress-precipitated seizures. Van Campen et al. reveal a positive relation between non-stress-related ultradian cortisol fluctuations and interictal epileptiform discharges, which is seen only in those with stress-sensitive seizures. This suggests that stress hormones can influence disease activity in epilepsy, also under basal conditions.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 (beta = 0.26, P = 0.002) in people reporting stress-sensitive seizures, but not those who did not report stress sensitivity (beta = -0.07, P = 0.64). The relationship between cortisol and epileptiform discharges was positively associated only with stress sensitivity of seizures (beta = 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.