Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures
Open accessAbstract
Summary: 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 α‐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.
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- Authors
- Bakvis, P., Spinhoven, P., Giltay, E. J., Kuyk, J., Edelbroek, P. M., Zitman, F. G., & Roelofs, K.
- Affiliations
- Leiden University (NL)
- Leiden University Medical Center (NL)
- Stichting Epilepsie Instellingen Nederland (NL)
- Corresponding author
- Bakvis, Patricia
- Venue
- Epilepsia
- Publisher
- Wiley
- Published
- 2010-04-22
- Volume
- 51
- Issue
- 5
- Pages
- 752-759
- ISSN
- 0013-9580 (ISSN-L)
- 1528-1167
- OpenAlex
- W2145734985
- Semantic Scholar
- 38d3ffde048de3c47e3eb903791507a8ada80a0e
- Cited by
- 132
- References
- 41
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 6 · 2023: 11 · 2022: 12 · 2021: 9 · 2020: 6 · 2019: 8 · 2018: 10 · 2017: 10 · 2016: 14 · 2015: 11 · 2014: 7 · 2013: 8 · 2012: 7
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epilepsia (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Universiteit Leiden
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (451-02-115)
- Leids Universitair Medisch Centrum
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Keywords
- psychogenic non-epileptic seizures, hypercortisolism, psychological trauma, hypothalamic-pituitary-adrenal axis, cortisol, sexual trauma, dexamethasone suppression test, cortisol awakening response, diurnal cortisol rhythm, sympathetic activity, alpha-amylase
- MeSH terms
- Adult, Age Factors, Circadian Rhythm, Cushing Syndrome, Dexamethasone, Electroencephalography, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Pituitary-Adrenal System, Saliva, Seizures, Sex Factors, Sex Offenses, Stress, Psychological, Biomarkers, Salivary alpha-Amylases
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