Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-04T21:40:48.175Z Has data issue: false hasContentIssue false

Predicting psychogenic non-epileptic seizures from serum levels of neuropeptide Y and adrenocorticotropic hormone

Published online by Cambridge University Press:  01 April 2019

Alessandro Miani
Affiliation:
Department of Nuclear Medicine and PET Center, Aarhus University, Denmark
Anders Sune Pedersen
Affiliation:
Department of Nuclear Medicine and PET Center, Aarhus University, Denmark
Charlotte Ulrikka Rask
Affiliation:
Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Denmark
Lori Uber-Zak
Affiliation:
Department of Neurology, Loma Linda University Medical Center, Loma Linda, CA, USA
Paul J. Zak
Affiliation:
Center for Neuroeconomics Studies, Claremont Graduate University, Claremont, CA, USA
Michael Winterdahl*
Affiliation:
Department of Nuclear Medicine and PET Center, Aarhus University, Denmark
*
Author for correspondence: Michael Winterdahl, Associated Professor in Neuroimaging, Department of Nuclear Medicine and PET Center, Aarhus University, Nørrebrogade 44, DK-8000 Aarhus C, Denmark. Tel: (+45) 7846 3016; Fax: (+45) 7846 3020; E-mail: [email protected]

Abstract

Objective

Patients with psychogenic non-epileptic seizures (PNES) may present with convulsive events that are not accompanied by epileptiform brain activity. Video-electroencephalography (EEG) monitoring is the gold standard for diagnosis, yet not all patients experience convulsive episodes during video-EEG sessions. Hence, we aimed to construct a predictive model in order to detect PNES from serum hormone levels, detached from an evaluation of patients’ convulsive episodes.

Methods

Fifteen female patients with PNES and 60 healthy female controls participated in the study, providing blood samples for hormone analysis. A binomial logistic regression model and the leave-one-out cross-validation were employed.

Results

We found that levels of neuropeptide Y and adrenocorticotropic hormone were the optimal combination of predictors, with over 90% accuracy (area under the curve=0.980).

Conclusions

The ability to diagnose PNES irrespective of convulsive events would represent an important step considering its feasibility and affordability in daily clinical practice.

Type
Short Communication
Copyright
© Scandinavian College of Neuropsychopharmacology 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Benbadis, SR (2005) A spell in the epilepsy clinic and a history of ‘chronic pain’ or ‘fibromyalgia’ independently predict a diagnosis of psychogenic seizures. Epilepsy Behav 6, 264265.Google Scholar
2. Devinsky, O, Gazzola, D Lafrance, WC (2011) Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol 7, 210220.Google Scholar
3. Alsaadi, TM Marquez, AVV (2005) Psychogenic nonepileptic seizures. Am Fam Physician 72, 849856.Google Scholar
4. Syed TU, LaFrance WC, Kahriman ES, Hasan SN, Rajasekaran V, Gulati D, Borad S, Shahid A, Fernandez‐Baca G, Garcia N, Pawlowski M, Loddenkemper T, Amina S and Koubeissi MZ (2011) Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol 69, 9971004.Google Scholar
5. Vinton A, Carino J, Vogrin S, MacGregor L, Kilpatrick C, Matkovic Z and O’Brien TJ (2004) ‘Convulsive’ nonepileptic seizures have a characteristic pattern of rhythmic artifact distinguishing them from convulsive epileptic seizures. Epilepsia 45, 13441350.Google Scholar
6. LaFrance, WC, Leaver, K, Stopa, EG, Papandonatos, GD Blum, AS (2010) Decreased serum BDNF levels in patients with epileptic and psychogenic nonepileptic seizures. Neurology 75, 12851291.Google Scholar
7. LaFrance, WCJ, Baker, GA, Duncan, R, Goldstein, LH Reuber, M (2013) Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia 54, 20052018.Google Scholar
8. Chen, DK, So, YT Fisher, RS (2005) Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 65, 668675.Google Scholar
9. Winterdahl M, Miani A, Vercoe MJH, Ciovica A, Uber-Zak L, Rask CU and Zak PJ (2017) Vulnerability to psychogenic non-epileptic seizures is linked to low neuropeptide Y levels. Stress 20.Google Scholar
10. Sah, R, Geracioti, TD Neuropeptide, Y (2013) and posttraumatic stress disorder. Mol Psychiatry 18, 646655.Google Scholar
11. Southwick, SM Charney, DS (2012) The science of resilience: implications for the prevention and treatment of depression. Science 338, 7982.Google Scholar
12. Kovac, S Walker, MC (2013) Neuropeptides in epilepsy. Neuropeptides 47, 467475.Google Scholar
13. Bakvis P, Spinhoven P, Giltay EJ, Kuyk J, Edelbroek PM, Zitman FG and Roelofs K (2010) Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures. Epilepsia 51, 752759.Google Scholar
14. Zhang, S-W Liu, Y-X (2008) Changes of serum adrenocorticotropic hormone and cortisol levels during sleep seizures. Neurosci Bull 24, 8488.Google Scholar
15. Alper, K, Devinsky, O, Perrine, K, Vazquez, B Luciano, D (1993) Nonepileptic seizures and childhood sexual and physical abuse. Neurology 43, 19501953.Google Scholar
16. Oto, M, Conway, P, McGonigal, A, Russell, AJ Duncan, R (2005) Gender differences in psychogenic non-epileptic seizures. Seizure 14, 3339.Google Scholar
17. Jacobs, DF (2002) Jacobs Neglect, Abandonment and Abuse Protocol (J-NAAP). Redlands, CA: Author.Google Scholar
18. Beck, AT, Ward, CH, Mendelson, M, Mock, J Erbaugh, J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4, 561571.Google Scholar
19. Forman, G Scholz, M (2010) Apples-to-apples in cross-validation studies. ACM SIGKDD Explor Newsl 12, 4957.Google Scholar
20. Avbersek, A Sisodiya, S (2010) Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry 81, 719725.Google Scholar
21. James, G, Witten, D, Hastie, T Tibshirani, R (2013) An introduction to statistical learning — with applications in R. Springer Texts in Statistics; vol. 103. New York, NY: Springer New York. 618 p.Google Scholar
22. Tabachnick, BG Fidell, LS (2007) Using Multivariate Statistics, 5th edn. New York, NY: Pearson Education Inc.Google Scholar
23. Heuser IJ, Gotthardt U, Schweiger U, Schmider J, Lammers CH, Dettling M and Holsboer F (1994) Age-associated changes of pituitary-adrenocortical hormone regulation in humans: importance of gender. Neurobiol Aging 15, 227231.Google Scholar
24. Baranowska, B, Radzikowska, M, Wasilewska-Dziubinska, E, Roguski, K Polonowski, A (2000) Relationship among leptin, neuropeptide Y, and galanin in young women and in postmenopausal women. Menopause 7, 149155.Google Scholar
25. Baker DG, Bertram TM, Patel PM, Barkauskas DA, Clopton P, Patel S, Geracioti TD, Haji U, O’Connor DT, Nievergelt CM and Hauger RL (2013) Characterization of cerebrospinal fluid (CSF) and plasma NPY levels in normal volunteers over a 24-h timeframe. Psychoneuroendocrinology 38, 23782382.Google Scholar
26. Löckinger A, Köberle D, König PS, Saria A, Herold M, Cornélissen G and Halberg F (2004) Neuropeptide chronomics in clinically healthy young adults: circaoctohoran and circadian patterns. Peptides 25, 533542.Google Scholar
27. Sah R, Ekhator NN, Strawn JR, Sallee FR, Baker DG, Horn PS and Geracioti TD (2009) Low cerebrospinal fluid neuropeptide Y concentrations in posttraumatic stress disorder. Biol Psychiatry 66, 705707.Google Scholar
28. Morgan CA, Rasmusson AM, Winters B, Hauger RL, Morgan J, Hazlett G and Southwick SM (2003) Trauma exposure rather than posttraumatic stress disorder is associated with reduced baseline plasma neuropeptide-Y levels. Biol Psychiatry 54, 10871091.Google Scholar