IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain; International University of Valencia, C/Pintor Sorolla, 21, 46002, Valencia, Spain.
IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain.
Neurosci Biobehav Rev. 2019 Aug;103:216-229. doi: 10.1016/j.neubiorev.2019.05.023. Epub 2019 May 23.
Stress has been suggested as a trigger factor for seizures in epilepsy patients, but little is known about cortisol levels, as indicators of stress, in adults with epilepsy. This systematic review summarizes the evidence on this topic. Following PRISMA guidelines, 38 articles were selected: 14 analyzing basal cortisol levels, eight examining antiepileptic drugs (AEDs) effects, 13 focused on seizure effects, and three examining stress. Higher basal cortisol levels were found in patients than in healthy people in studies with the most homogeneous samples (45% of 38 total studies). Despite heterogeneous results associated with AEDs, seizures were related to increases in cortisol levels in 77% of 38 total studies. The only study with acute stress administration found higher cortisol reactivity in epilepsy than in healthy controls. In studies using self-reported stress, high seizure frequency was related to increased cortisol levels and lower functional brain connectivity. Findings suggest that epilepsy could be considered a chronic stress model. The potential sensitizing role of accumulative seizures and issues for future research are discussed.
压力被认为是癫痫患者癫痫发作的触发因素，但对于癫痫患者的皮质醇水平（压力的指标）知之甚少。本系统综述总结了这一主题的证据。根据 PRISMA 指南，共选择了 38 篇文章：14 篇分析基础皮质醇水平，8 篇研究抗癫痫药物 (AED) 的作用，13 篇关注癫痫发作的影响，3 篇研究压力。在具有最同质样本的研究中（38 项总研究中的 45%），发现患者的基础皮质醇水平高于健康人。尽管与 AED 相关的结果存在异质性，但在 38 项总研究中的 77%中，癫痫发作与皮质醇水平升高有关。唯一一项使用急性应激管理的研究发现，癫痫患者的皮质醇反应性高于健康对照组。在使用自我报告的应激的研究中，高癫痫发作频率与皮质醇水平升高和功能性脑连接降低有关。研究结果表明，癫痫可以被认为是一种慢性应激模型。讨论了累积性癫痫发作的潜在致敏作用和未来研究的问题。
