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

Abstract

ObjectivePatients 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.MethodsFifteen 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.ResultsWe 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).ConclusionsThe ability to diagnose PNES irrespective of convulsive events would represent an important step considering its feasibility and affordability in daily clinical practice.

A systems biology approach for discovering the cellular and molecular aspects of psychogenic non-epileptic seizure

“…POMC, which is a prohormone of ACTH, is mainly produced in the neurons of the pituitary and hypothalamus (45). In a previous study, the baseline amount of ACTH was greater than the normal group showing the hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis (42).…”

“…This elevation of S100B could be detected in the blood because of the increase in blood-brain barrier drainage and elevated ACTH (43). It should be mentioned that the elevation of ACTH in PNES patients had been detected before (42). Further studies are needed to find the role of S100B in PNES patients and also for the confirmation of S100B as a PNES biomarker.…”

“…Previous studies found low levels of NPY in PNES patients (41). Moreover, it was found that the combination of NPY and ACTH could differentiate healthy patients from PNES ones (42). NPY is a neurotransmitter of the sympathetic system, which can affect the secretion of ACTH and as a result the HPA axis (41).…”

“…Because there is limited evidence about the molecular pathomechanism of PNES, and as the involved regions of the brain in PNES have not been found yet, discovering regions that secrete specific biomarkers can be helpful for further studies. During the literature review process, BDNF (39), growth hormone 1 (GH1) (40), NPY (41,42), PRL (41), and S100B (43) were found with altered concentrations in the blood. Among all of them, just S100B's concentration was increased in the (43).…”

“…NPY is another neurotransmitter whose downregulation was reported in PNES patients (41,42). NPY has a medium score of expression in different organs such as the cerebral cortex, adrenal gland, testis, prostate, and soft tissues.…”