Stress is a common seizure trigger in persons with epilepsy. The body’s physiological response to stress is mediated by the hypothalamic-pituitary-adrenal (HPA) axis and involves a hormonal cascade that includes corticotropin releasing hormone (CRH), adrenocorticotropin releasing hormone (ACTH) and the release of cortisol (in humans and primates) or corticosterone (in rodents). The prolonged exposure to stress hormones may not only exacerbate pre-existing medical conditions including epilepsy, but may also increase the predisposition to psychiatric comorbidities. Hyperactivity of the HPA axis negatively impacts the structure and function of the temporal lobe of the brain, a region that is heavily involved in epilepsy and mood disorders like anxiety and depression. Seizures themselves damage temporal lobe structures, further disinhibiting the HPA axis, setting off a vicious cycle of neuronal damage and increasing susceptibility for subsequent seizures and psychiatric comorbidity. Treatments targeting the HPA axis may be beneficial both for epilepsy and for associated stress-related comorbidities such as anxiety or depression. This paper will highlight the evidence demonstrating dysfunction in the HPA axis associated with epilepsy which may contribute to the comorbidity of psychiatric disorders and epilepsy, and propose treatment strategies that may dually improve seizure control as well as alleviate stress related psychiatric comorbidities.

压力是癫痫患者常见的癫痫发作诱因。人体对压力的生理反应是由下丘脑-垂体-肾上腺（HPA）轴介导的，涉及激素级联反应，包括促肾上腺皮质激素释放激素（CRH），促肾上腺皮质激素释放激素（ACTH）和皮质醇的释放（在人类和灵长类动物中）或皮质酮（在啮齿动物中）。长时间暴露于应激激素中不仅可能加剧包括癫痫病在内的既往医疗状况，而且还可能增加精神病合并症的易感性。HPA轴的过度活动会对大脑颞叶的结构和功能产生负面影响，该区域严重参与癫痫症和焦虑症和抑郁症等情绪障碍。癫痫发作本身会损害颞叶结构，进一步抑制HPA轴，引发神经元损伤的恶性循环，并增加了随后发作和精神病合并症的易感性。针对HPA轴的治疗可能对癫痫和与压力相关的合并症（如焦虑症或抑郁症）均有益。本文将重点介绍与癫痫相关的HPA轴功能障碍的证据，这可能会导致精神疾病和癫痫合并症，并提出可双重改善癫痫发作控制并减轻与压力相关的精神疾病合并症的治疗策略。针对HPA轴的治疗可能对癫痫和与压力相关的合并症（如焦虑症或抑郁症）均有益。本文将重点介绍与癫痫相关的HPA轴功能障碍的证据，这可能导致精神疾病和癫痫合并症，并提出可以双重改善癫痫发作控制并减轻与压力有关的精神疾病合并症的治疗策略。针对HPA轴的治疗可能对癫痫和与压力相关的合并症（如焦虑症或抑郁症）均有益。本文将重点介绍与癫痫相关的HPA轴功能障碍的证据，这可能会导致精神疾病和癫痫合并症，并提出可双重改善癫痫发作控制并减轻与压力相关的精神疾病合并症的治疗策略。