On the Relationship Between Adrenal Cortical Activity and The Convulsive State

'l'here is still ;I great lack of knowledge conterliing the niechariisni of the spontaneous electrical discharge o[ cerebral neurons in "idiopathic" seizure states. Hughlings Jackson (35) considered the iiietabolic factor when he stated. "l'lie highly unstable nervous matter of disease (ill ;I 'discharging lesion') differs in compositioii, but not iii constitution lroni the coini)iirati\. ely stable grey matter of health. Tlie alteration i i i coiiilmsitioii is of course siicli that the ncrvous substance formed is more explo bivc. " I t is the purpose of this review to iiidicate one possible aspect of this problem: the relationship between the activity of the adrenal cortex, particularly with regard to electrolyte iiietabolism, and the convulsive state. This especially applies to the Occurrence of seizures triggered under circumstances of physiological and psychological stress. The physiologic actions of the hormones (68) of the adrenal cortex are concerned with electrolyte and water metabolism (Na-K hormone or desoxycorticosterone. DCA group). sugar, fat and nitrogen metabolism (11-17 oxycorticosteroid or cortisone-hydrocortisone group) and tlermatotropic and androgenic actions (1 7ketosteroid precursors). Excess of DCA results i i i a negative potassium balance with low SCNIII potassium, intracellular potassium depletion, and a positive sodium balance with elevated serium sodium and expansion of extracellular water volume. Also. sodium tends to migrate into cells and replace or displace potassium. -4 deficiency of DCA results in the reverse. Certain similar, but less intensive, electrolyte changes are produced by the horinoiies of the 11-1 7 oxycorticosteroid group. However. the major effect of these hormones that is oL present concern is that related to carbohydrate metabolism. Excess results in a tendency to hyperglycemia. probably chiefly by inhibiting peripheral glucose utilization. Lack tends to produce hypoglycemia, probably due to an absolute increase in peripheral glucose utiliLation and a failure of gluconeogenesis. The adreiiocorticotropic hormone of the pituitary stiinulates primarily the production of these latter hormones from the adrenal cortex. There have been several studies concerned with the relationship between water m e t a b lisni, brain cell permeability, electrolyte balance and convulsions. McQuame (45, 47) demonstrated the sensitivity of epileptic patients to sudden water storage with hypotonic dilution of extracellular fluid and proposed the hydration test. Also, an increase in potas sium excretion was found to occur during hydration 12 to 36 hours before the seizures. However, under ordinary conditions the water metabolism of epileptic patients is within normal limits (65). It has been shown (59) that cortical permeability is increased by conditions which produce a lowered seizure threshold or actual seizures. The cerebral venous blood of dogs was reported to contain an increased amount of potassium during induced ~eizurr~. representing a loss from brain (8). Colfer (9). using microincineration and rniaocrystalI0graphic techniques, demonstrated. fouowing experimental seizures in rats. a redistribution