SERUM CORTISOL AND CEREBROSPINAL-FLUID BETA-ENDORPHINS IN STATUS EPILEPTICUS - THEIR POSSIBLE RELATION TO PROGNOSIS

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.