PDF(Pubmed)
Abstract：
The hypothalamic-pituitary-adrenal axis is known to be involved in the pathogenesis of epilepsy and psychiatric disorders. Epileptic seizures (ESs) and psychogenic non-epileptic seizures (PNESs) are frequently differentially misdiagnosed. This study aimed to evaluate changes in serum cortisol and prolactin levels after ESs and PNESs as possible differential diagnostic biomarkers. Patients over 18 years with ESs (n = 29) and PNESs with motor manifestations (n = 45), captured on video-EEG monitoring, were included. Serum cortisol and prolactin levels as well as hemograms were assessed in blood samples taken at admission, during the first hour after the seizure, and after 6, 12, and 24 h. Cortisol and prolactine response were evident in the ES group (but not the PNES group) as an acute significant increase within the first hour after seizure. The occurrence of seizures in patients with ESs and PNESs demonstrated different circadian patterns. ROC analysis confirmed the accuracy of discrimination between paroxysmal events based on cortisol response: the AUC equals 0.865, with a prediction accuracy at the cutoff point of 376.5 nmol/L 0.811 (sensitivity 86.7%, specificity 72.4%). Thus, assessments of acute serum cortisol response to a paroxysmal event may be regarded as a simple, fast, and minimally invasive laboratory test contributing to differential diagnosis of ESs and PNESs.
摘要：
已知下丘脑-垂体-肾上腺轴与癫痫和精神疾病的发病机理有关。癫痫发作（ESs）和心因性非癫痫发作（PNESs）经常被误诊。这项研究旨在评估ESs和PNESs作为可能的鉴别诊断生物标志物后血清皮质醇和催乳素水平的变化。18岁以上的ESs患者（n=29）和有运动表现的PNESs患者（n=45），在视频脑电图监测中捕获，包括在内。在入院时采集的血液样本中评估血清皮质醇和催乳素水平以及血常规。在癫痫发作后的第一个小时，在癫痫发作后的第一个小时内，ES组（而非PNES组）的皮质醇和催乳素反应明显。ESs和PNESs患者癫痫发作的发生表现出不同的昼夜节律模式。ROC分析证实了基于皮质醇反应的阵发性事件之间的区分的准确性：AUC等于0.865，在376.5nmol/L0.811的截止点的预测准确性（灵敏度86.7％，特异性72.4%)。因此，评估急性血清皮质醇反应的阵发性事件可以被认为是一个简单的，快,和微创实验室检查有助于ESs和PNESs的鉴别诊断。
