Serum cortisol and cerebrospinal fluid beta-endorphins in status epilepticus. Their possible relation to prognosis
V. P. Calabrese, H. D. Gruemer, H. L. Tripathi, W. Dewey, C. A. Fortner and R. J. DeLorenzo
Department of Neurology, Medical College of Virginia, Richmond 23298.
OBJECTIVE--To determine if blood cortisol and cerebrospinal fluid
beta-endorphin levels correlate with prognosis following status
epilepticus. DESIGN--Twenty-seven adult patients with status epilepticus
had blood cortisol and cerebrospinal fluid beta-endorphin levels measured
within 12 hours after the cessation of clinical seizures. SETTING--Patients
with status epilepticus as well as patients with non-status epilepticus
seizures came from the Comprehensive Epilepsy Program at the Medical
College of Virginia, Richmond. PATIENTS--Twenty-seven patients with status
epilepticus. Control patients for the cortisol study were patients who had
acute seizures who did not meet the criteria for status epilepticus. The
cerebrospinal fluid control subjects were patients without neurologic
symptoms undergoing spinal anesthesia. OUTCOME MEASURES--The clinical
status of the patients 1 week after status epilepticus as well as the
Glascow Outcome Score and the Glascow Coma Score 1 week after status
epilepticus. RESULTS--The difference in blood cortisol levels in patients
with status epilepticus with poor prognosis was significantly different
from both patients with non-status epilepticus seizures (P < .001) and
patients with status epilepticus with good prognosis (P < .01).
Cerebrospinal fluid beta-endorphin levels were elevated in patients with
status epilepticus patients vs control subjects (P < .05), but no
significant difference was noted between the patients with status
epilepticus with good and poor prognosis. CONCLUSIONS--Serum cortisol
levels may provide a useful predictive indicator of prognosis in status
epilepticus and cortisol level elevation may play a role in the
pathophysiologic condition of status epilepticus.
