Sex differences in cortisol levels and their relationship with memory and negative affectivity in patients with drug-resistant epilepsy

Abstract

Drug-resistant epilepsy can be considered a chronic stress condition characterized by uncontrollable seizures together with cognitive and affective alterations. Epilepsy and its treatments affect men and women differently, potentially due to interactions with sexual hormones that influence how they experience the condition. This study examines potential sex differences in cortisol levels (as the product of stress processes), affectivity, and memory in patients with drug-resistant epilepsy, and the relationships among these variables. The sample was composed of 96 adult patients with drug-resistant epilepsy (M = 38.01 ± 11.12 years; 47 men and 49 women). Results show that men had higher evening cortisol levels and cortisol area under the curve (AUC_i) than women (for both, p < .05), especially in those with a left hemisphere focus. Men also showed higher trait anxiety, higher DDD and poorer memory than women. In the total sample, trait anxiety and the DDD significantly predicted poor immediate and delayed memory, controlling for the side of seizure focus and effects of epilepsy type (p < .001). When analyses were stratified by sex, cortisol AUC_i predicted poorer delayed memory in men but not in women, while DDD predicted memory performance only in women. These findings suggest that cortisol, trait anxiety and the DDD are reliable predictors of memory impairment in patients with drug-resistant epilepsy, with a sex-differential pattern of relationships. Our results highlight the importance of considering sex differences and clinical variables when developing tailored treatment approaches for this population.