Relationship between seizure cluster of temporal lobe epilepsy with hippocampal sclerosis and cortisol rhythm change / 中华神经科杂志

ABSTRACT

Objective:To explore the relationship between seizure cluster of temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and cortisol (COR) rhythm, and understand its mechanism from the perspective of neuroendocrine.Methods:Fifty-seven patients with unilateral TLE-HS were recruited from the Qinghai Provincial People′s Hospital from May 1st 2012 to December 31st 2020. According to the history of seizure clusters one month before admission, 27 patients were enrolled in seizure clusters group (SC group), 30 patients were included in without seizures cluster group (NSC group). The clinical characteristics were systematically analyzed and compared between the SC and NSC groups. Plasma COR levels were measured at 800, 1600 and 2400 (COR8, COR16 and COR0) on the same day, and bilateral magnetic resonance spectroscopy (MRS) diagnosis was performed in two groups. Independent sample t test, chi-square test, repeated analysis of variance, covariance analysis, and multivariate Logistic regression were used for statistical analysis. Results:Time effect, grouping effect and the interaction effect of the time and grouping in the level of COR were statistically significant. Covariance analysis excluded age as an influential factor, COR16, COR0 and the slope of COR8-16 in the SC group [(126.22±19.98) μg/L, (51.63±21.43) μg/L, -7.78±4.54] were higher than the NSC group [(97.70±18.55) μg/L, (31.90±10.73) μg/L, -12.40±4.16], and the difference was statistically significant ( F=5.587, 4.320, 4.013, all P<0.05). The slope of COR0-8 in the SC group (17.11±6.32) was lower than that in the NSC group (20.62±6.54), and the difference was statistically significant ( F=-2.065, P<0.05). There was no significant difference in lateralization of hippocampal sclerosis between the two groups, and there was no significant difference in the ratio of N-acetyl aspartic acid(NAA)/[choline(Cho)+creatinine(Cr)] in the unilateral hippocampal sclerosis zone of the two groups, but the NAA/(Cho±Cr) ratio of the contralateral hippocampus in the SC group (0.71±0.03) was lower than that in the NSC group (0.76±0.06),and the difference was statistically significant ( t=4.999, P=0.029). Multivariate Logistic regression analysis showed that COR16 ( OR=1.328, 95% CI 1.073-1.642, P=0.009), COR8-16 ( OR=3.657, 95% CI 1.404-9.525, P=0.008) were independent risk factors of seizure clusters in TLE-HS. Conclusion:COR rhythm disturbance may be the neuroendocrine basis of seizure clusters in patients with TLE-HS.