The hormonal responses to generalized tonic-clonic seizures.

We studied the hormonal responses to a generalized tonic-clonic convulsion in 20 patients with idiopathic or posttraumatic epilepsy (6 patients) or alcohol-withdrawal seizures (14 patients). We found an increase shortly after the seizure in plasma levels of ACTH, beta endorphin, beta lipotropin, prolactin, and vasopressin, and a later increase in plasma cortisol. There was no significant change in levels of growth hormone, luteinizing hormone, follicular stimulating hormone, or plasma renin activity. An increase in plasma ACTH level was accompanied by a rise in beta lipotropin and beta endorphin, and followed by a rise in plasma cortisol. In 2 patients there was no postictal increase in plasma prolactin, despite changes in other hormones. There was no difference in the nature or time course of the hormonal changes in patients with alcohol-withdrawal seizures and those with seizures from other causes. The mechanisms subserving these changes are unknown. Nonspecific stress influences the release of certain hormones, but the absence of a significant growth hormone response suggests that this was probably not responsible for our findings. It is possible that the generalized neuronal discharge of a seizure stimulates the hypothalamus either directly, through specific neurotransmitter changes, or through the release of other substances. One possibility that we are investigating in experimental animals is that endogenous opioids are involved, especially in the release of prolactin.