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Shen J, Li DL, Tan XX, Tao WW, Xie CJ, Shi XG, Wang Y. A transcranial sonography study of brainstem and its association with depression in idiopathic generalized epilepsy with tonic-clonic seizures. Epilepsy Behav 2020; 102:106589. [PMID: 31726317 DOI: 10.1016/j.yebeh.2019.106589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/19/2019] [Accepted: 09/22/2019] [Indexed: 01/18/2023]
Abstract
Brainstem raphe (BR) hypoechogenicity in transcranial sonography (TCS) has been depicted in patients with depression. But, up to date, the association of BR alterations in TCS with depression in patients with epilepsy has never been reported. This study was to investigate the possible role of BR examination via TCS in patients with idiopathic generalized epilepsy with tonic-clonic seizures (IGE-TCS) and depression. Forty-six patients with IGE-TCS and 45 healthy controls were recruited. Echogenicity of the caudate nuclei (CN), lentiform nuclei (LN), substantia nigra (SN), and BR and widths of the lateral ventricle (LV) frontal horns and the third ventricle (TV) were assessed via TCS. The determination of depression was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), and depression severity measured by Chinese version Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E) and Beck Depression Inventory-II (BDI-II). The width of TV in patients with epilepsy was found significantly larger than that in healthy controls (p = 0.001), but there was no significant difference in TV width between patients with IGE-TCS with and without depression. There were no significant differences between patients with IGE-TCS and healthy controls in LV frontal horn width, as well as in SN, CN, LN, and BR echogenicity. Here, it seems that patients with IGE-TCS were detected with smaller SN echogenic area compared with controls though they had no statistical significance. Patients with IGE-TCS with hypoechogenic BR had significantly higher C-NDDI-E and BDI-II scores than those with normal BR signal, and most patients with IGE-TCS with depression exhibited hypoechogenic BR, but few patients with IGE-TCS without depression exhibited hypoechogenic BR. In conclusion, BR echogenic signal alterations in TCS can be a biomarker for depression in epilepsy, but it might not be associated with epilepsy itself. The alterations of SN echogenic area and TV width in TCS may reflect a potential role of SN and diencephalon structure in the pathogenesis of epilepsy, which needs to be further elucidated.
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Affiliation(s)
- Jie Shen
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Dong-Lin Li
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xiu-Xiu Tan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Wei-Wei Tao
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Cheng-Juan Xie
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xue-Gong Shi
- Department of Echocardiography, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China; Department of Neurology, the Fourth Affiliated Hospital of Anhui Medical University, Huaihai Avenue 100, Hefei 230000, China.
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Zapata Barco AM, Restrepo-Martínez M, Restrepo D. Depression in People with Epilepsy. What is the Connection? REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:53-61. [PMID: 32081210 DOI: 10.1016/j.rcp.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Depression is the most common psychiatric comorbidity in people with epilepsy. It worsens the prognosis and quality of life of these patients. Despite this, depression is poorly diagnosed and when the treatment is given, it is frequently suboptimal. OBJECTIVE To perform a narrative review of the medical literature, seeking to collect useful information regarding the relationship between epilepsy and depression. RESULTS Narrative reviews, systematic reviews, meta-analyses, clinical trials, and follow-up studies were identified in English and Spanish with no time limit, including epidemiological, clinical, associated factors, etiological explanations, diagnostic and therapeutic approaches to comorbid depression in epilepsy. CONCLUSION The relationship between epilepsy and depression is complex. The available scientific evidence suggests the possibility of a bidirectional relationship that could be explained from common aetiopathogenic mechanisms. Despite the high prevalence of depression in epileptic patients, this mental disorder continues to be poorly identified by clinicians. To improve this, we have easy-to-apply instruments that routinely screen this patient population and contribute substantially to making the problem more visible and seek to improve the quality of life for this population.
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Gil‐Nagel A, Álvarez Carriles J, Bermejo P, Carreño M, García‐Morales I, García Peñas JJ, López‐González FJ, Ruíz‐Falcó M, Sánchez JC, Tato C. Consensus statement for the management of generalized tonic-clonic seizures in Spain. Acta Neurol Scand 2020; 141:22-32. [PMID: 31529468 DOI: 10.1111/ane.13169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/08/2019] [Accepted: 09/10/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop recommendations for the management of patients with primary or secondary generalized tonic-clonic seizures (GTCS) based on best evidence and experience. METHODS The Delphi methodology was followed. A multidisciplinary panel of 10 experts was established, who defined the scope, users and preliminary recommendations. Systematic and narrative reviews of the current literature were performed to assess data on the risk of sudden unexpected death in epilepsy and the efficacy and safety of add-on therapy in patients with GTCS. Twenty-five definitive recommendations were generated which were then graded on a scale of 1 (totally disagree) to 10 (totally agree) by the experts and 45 neurologists. Consensus was reached if at least 70% of the participants applied a score of ≥7. Each recommendation was then assigned a level of evidence, a grade of agreement and a grade of recommendation. The entire process was supervised by an expert methodologist. RESULTS Overall, 24 out of 25 recommendations achieved consensus. These included specific recommendations on diagnosis, evaluation and treatment. The recommendations also emphasized the importance of proper psychological evaluation and effective communication between patients and health professionals, and the importance of patient and family education and support. SIGNIFICANCE The recommendations generated by this consensus can be used as a guide for the diagnosis and management of patients with GTCS.
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Affiliation(s)
| | | | | | - Mar Carreño
- Hospital Clinic de Barcelona Barcelona Spain
| | | | | | | | | | - Juan Carlos Sánchez
- Complejo Hospitalario Universitario Parque Tecnológico de la Salud Granada Spain
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Atalar AÇ, Vanlı-Yavuz EN, Yılmaz E, Bebek N, Baykan B. Reflex epileptic features in patients with focal epilepsy of unknown cause. Clin Neurol Neurosurg 2019; 190:105633. [PMID: 31865219 DOI: 10.1016/j.clineuro.2019.105633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/09/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES There is a gap of knowledge regarding reflex seizures in patients with focal epilepsy of unknown cause (FEUC). We aimed to evaluate the prevalence, demographic and clinical characteristics of reflex seizures in patients with FEUC to provide an insight to the underlying ictogenic mechanisms and to draw attention to this important but under-investigated topic. PATIENTS AND METHODS After carefully questioning for reflex triggers, 186 patients diagnosed according to ILAE criteria and followed-up for a minimum of 5 years were included. The demographic and clinical properties as well as electrophysiological and neuroimaging data of these patients were reevaluated and compared to the patients without reflex seizures. RESULTS The reflex seizure rate was 6.5 % in patients with FEUC. Patients with reflex features had lower monotherapy rates (p = 0.005) and higher major depression rates (p = 0.001) than patients without reflex features. The distribution of the patients according to their reflex triggers were as follows: hot-water induced (n = 3, 25 %), photosensitive (n = 2, 16.7 %), eating- induced (n = 2, 16.7 %), musicogenic (n = 2, 16.7 %), startle induced (n = 2, 16.7 %) and both musicogenic and startle type (n = 1, 8.3 %) respectively. The drug resistance rate of patients with reflex seizures was 25 % (n = 3). One patient with drug resistant reflex seizures showed benefit from epilepsy surgery and became seizure-free during last 3 years of follow-up. CONCLUSION A careful and thoroughly history taking specifically questioning and focusing on seizure inducing factors in patients with FEUC is needed to confirm the presence of reflex seizures in patients with FEUC, who had higher rates of polytherapy and major depression. Elaborative evaluation of reflex features in FEUC might contribute to effective seizure control, ensure new therapeutic approaches, enlighten the obscurity and the resulting anxiety of having a diagnosis of FEUC in epilepsy patients.
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Affiliation(s)
- Arife Çimen Atalar
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology Unit, Istanbul, Turkey; Istanbul Education and Research Hospital, Istanbul, Turkey.
| | - Ebru Nur Vanlı-Yavuz
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology Unit, Istanbul, Turkey; Koc University Hospital, Department of Neurology, Istanbul, Turkey
| | - Ebru Yılmaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul Turkey
| | - Nerses Bebek
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology Unit, Istanbul, Turkey
| | - Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology Unit, Istanbul, Turkey
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Silagadze K, Kasradze S, Silagadze T, Lomidze G. Validation of a Georgian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy Behav 2019; 101:106587. [PMID: 31698261 DOI: 10.1016/j.yebeh.2019.106587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study aimed to validate a Georgian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). The distribution of psychiatric disorders was assessed among patients with epilepsy. METHODS One hundred and thirty consecutive adult patients with epilepsy completed the NDDI-E and the Beck Depression Inventory (BDI). All patients were further assessed by a qualified psychiatrist. RESULTS In 31 (23.8%) patients, a diagnosis of major depression was revealed. The internal consistency of the NDDI-E was 0.695. Receiver operating characteristics (ROC) showed an area under the curve of 0.975. A cutoff score of ≥16 resulted in a sensitivity of 0.90 and a specificity of 0.939. The screening questionnaire showed a significantly positive correlation with BDI scores (Spearman's rho - 0.684), indicating good concurrent validity. DISCUSSION The Georgian version of the NDDI-E is a reliable tool for the detection of depressive disorders in individuals with epilepsy.
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Affiliation(s)
- Ketevan Silagadze
- Institute of Neurology and Neuropsychology, 83/11 Vaja-Pshavela Ave., 0186 Tbilisi, Georgia; Tbilisi State Medical University, 33 Vaja-Pshavela Ave., 0186 Tbilisi, Georgia
| | - Sofia Kasradze
- Caucasus International University, 73 Chargali Str., 0141 Tbilisi, Georgia; Institute of Neurology and Neuropsychology, 83/11 Vaja-Pshavela Ave., 0186 Tbilisi, Georgia
| | - Teimuraz Silagadze
- Tbilisi State Medical University, 33 Vaja-Pshavela Ave., 0186 Tbilisi, Georgia
| | - Giorgi Lomidze
- Caucasus International University, 73 Chargali Str., 0141 Tbilisi, Georgia; Institute of Neurology and Neuropsychology, 83/11 Vaja-Pshavela Ave., 0186 Tbilisi, Georgia.
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Hum KM, Chan CJ, Gane J, Conway L, McAndrews MP, Smith ML. Do distance-delivery group interventions improve depression in people with epilepsy? Epilepsy Behav 2019; 98:153-160. [PMID: 31374471 DOI: 10.1016/j.yebeh.2019.06.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/18/2019] [Accepted: 06/27/2019] [Indexed: 01/20/2023]
Abstract
About one-third of people with epilepsy experience comorbid depression. The present study examined outcomes of a distance-delivery group intervention program designed to improve emotional well-being. Participants were 55 adults with epilepsy and self-reported depressive symptoms who were randomly assigned to take part in either a mindfulness-based cognitive behavioral therapy (CBT) program (UPLIFT, n = 20), an epilepsy information and self-management program (EpINFO, n = 24) that served as an active control group, or a wait-list control (WLC) group (n = 11). The Quick Inventory of Depressive Symptomatology (QIDS), Neurological Disorders Depression Inventory for Epilepsy (NDDIE), and the psychological health subscale of the World Health Organization Quality of Life (WHOQOL-BREF) scale were used to assess depression and psychological quality of life before and after treatment, and at short-term (six months) and long-term follow-up (one year) upon program completion. From pre- to posttreatment, a main effect of time was found, with participants in both the UPLIFT and EpINFO groups having reported to a similar degree a significant decrease in depressive symptoms and improved psychological health, improvements that were not seen in the WLC group. The time by group interaction effect was not significant. The effects seen at posttreatment in the UPLIFT and EpINFO groups remained at six months and one year after treatment. These data suggest that distance-delivery group intervention programs are effective at improving depression and psychological quality of life, with the EpINFO program offering benefits similar to the UPLIFT program.
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Affiliation(s)
| | | | | | - Lauryn Conway
- University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Pat McAndrews
- University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Mary Lou Smith
- University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
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Hartshorn A, Kobylarz E, Andrew AS, Jobst BC, Bujarski K. Balance and reaction time do not rapidly improve off antiseizure drugs. Epilepsy Behav 2019; 97:158-160. [PMID: 31252272 DOI: 10.1016/j.yebeh.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE People with epilepsy (PWE) exercise less than the general population and describe a lower level of fitness. Exercise improves comorbidities associated with epilepsy and may help seizure control. We aimed to record balance and reaction time in patients undergoing antiseizure drug (ASD) taper in the epilepsy monitoring unit (EMU) to determine if there is a reversible, dose-dependent effect of these medications. METHODS We tested 21 patients and 21 controls using a Wii Balance Board (WBB) and online reaction time test. The patients were recruited during an EMU stay and were tested before and after medication taper. Drug levels were also checked. Sway from center of pressure (COP) and speed of sway were tested with eyes open on two legs, eyes closed on two legs, and eyes open on one leg. Reaction time was tested. RESULTS Compared with controls, patients on ASDs had more sway from COP (with eyes open on two legs: p = 0.0022 in the anterior-posterior axis and p = 0.022 in the medial-lateral axis using linear regression) and worse reaction time (p < 0.001 using linear regression, adjusted for age and gender). There was no difference in reaction time or sway from COP between trials 1 and 2, before and after stopping ASDs (p = 0.2 using a paired t test for reaction time and p = 0.08 using a paired t test for speed of sway with eyes closed). There was no relationship between time since last seizure or duration of seizures and balance or reaction time. DISCUSSION Balance and reaction time in patients on ASD is impaired compared with controls. There is no immediate improvement in these measures following ASD withdrawal. This difference may result from vestibular or cerebellar effects. More research is needed to determine the individual effects of particular medications on balance and reaction time.
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Affiliation(s)
- Alendia Hartshorn
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America.
| | - Erik Kobylarz
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Angeline S Andrew
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Barbara C Jobst
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Krzysztof Bujarski
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
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Zangiabadi N, Ladino LD, Sina F, Orozco-Hernández JP, Carter A, Téllez-Zenteno JF. Deep Brain Stimulation and Drug-Resistant Epilepsy: A Review of the Literature. Front Neurol 2019; 10:601. [PMID: 31244761 PMCID: PMC6563690 DOI: 10.3389/fneur.2019.00601] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/21/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction: Deep brain stimulation is a safe and effective neurointerventional technique for the treatment of movement disorders. Electrical stimulation of subcortical structures may exert a control on seizure generators initiating epileptic activities. The aim of this review is to present the targets of the deep brain stimulation for the treatment of drug-resistant epilepsy. Methods: We performed a structured review of the literature from 1980 to 2018 using Medline and PubMed. Articles assessing the impact of deep brain stimulation on seizure frequency in patients with DRE were selected. Meta-analyses, randomized controlled trials, and observational studies were included. Results: To date, deep brain stimulation of various neural targets has been investigated in animal experiments and humans. This article presents the use of stimulation of the anterior and centromedian nucleus of the thalamus, hippocampus, basal ganglia, cerebellum and hypothalamus. Anterior thalamic stimulation has demonstrated efficacy and there is evidence to recommend it as the target of choice. Conclusion: Deep brain stimulation for seizures may be an option in patients with drug-resistant epilepsy. Anterior thalamic nucleus stimulation could be recommended over other targets.
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Affiliation(s)
- Nasser Zangiabadi
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Lady Diana Ladino
- Epilepsy Program, Hospital Pablo Tobón Uribe, Neuroclinica, University of Antioquia, Medellín, Colombia
| | - Farzad Sina
- Department of Neurology, Rasool Akram Hospital, IUMS, Tehran, Iran
| | - Juan Pablo Orozco-Hernández
- Departamento de Investigación Clínica, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira-Clínica Comfamiliar, Pereira, Colombia
| | - Alexandra Carter
- Saskatchewan Epilepsy Program, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Rashid H, Katyal J, Tripathi M, Sood M, Gupta YK. Validation of the Indian version of Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy Behav 2019; 95:75-78. [PMID: 31026787 DOI: 10.1016/j.yebeh.2019.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is an efficient tool for rapid detection of depression, an important comorbid condition in persons with epilepsy (PWE). Since social and cultural differences can potentially affect the cutoff score of NDDI-E, in this study, the reliability and validity of the Indian version of the NDDI-E in PWE was determined. METHOD After ethical clearance, 217 PWE above 18 years of age, on antiepileptic drugs (AEDs), attending neurology outpatient department (OPD) of All India Institute of Medical Sciences (AIIMS), New Delhi, India, were evaluated for depression using the NDDI-E (Indian version) and Mini International Neuropsychiatric Interview (MINI-Module A, version 6.0.0) as reference standard. Informed consent was taken before recruitment. Receiver operating characteristic (ROC) analysis and Cronbach's α, a measure of the internal consistency and reliability, were carried out to validate cutoff and questionnaire, respectively. RESULTS Of the 217 PWE (112 males/105 females), mean age of 28.6 ± 9.4 years, with generalized (69.1%) or focal seizures (30.9%), 41.5% and 10.6% were diagnosed with depression using MINI and NDDI-E Indian version (at cutoff >15), respectively. However, at a cutoff score of >11, the Indian version of NDDI-E had a sensitivity of 96.67%, a specificity of 84.25%, a positive predictive value of 81.31%, and a negative predictive value of 97.27%. ROC analysis showed an area under the curve (AUC) of 0.9547 (confidence interval (CI) 95% = 0.929-0.979; standard error (SE): 0.0127). With the Indian version of NDDI-E, the Cronbach's α value was 0.877. CONCLUSION A periodic assessment of PWE using a quickly administrable and reliable tool for screening depression is highly desirable given the high incidence. In the Indian population with a cutoff of >11, NDDI-E is a reliable and valid instrument to screen depression in PWE.
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Affiliation(s)
- Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Yogendra K Gupta
- Translational Health Science and Technology Institute, Faridabad, Haryana, India
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Doherty C, Hogue O, Floden DP, Altemus JB, Najm IM, Eng C, Busch RM. BDNF and COMT, but not APOE, alleles are associated with psychiatric symptoms in refractory epilepsy. Epilepsy Behav 2019; 94:131-136. [PMID: 30909076 PMCID: PMC8299517 DOI: 10.1016/j.yebeh.2019.02.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 02/28/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether three common genetic polymorphisms [apolipoprotein (APOE) ε4 (rs42938 and rs7412), brain derived neurotrophic factor (BDNF) Met (rs6265), and catechol-O-methyltransferase (COMT) Val (rs4680)] are associated with increased psychiatric symptomatology in individuals with pharmacoresistant epilepsy. METHODS One hundred forty-eight adults (Mage = 38 years; 53% female) with refractory epilepsy completed self-report measures of mood, anxiety, and/or personality/psychopathology. Mann-Whitney U, t-tests, and Fisher's exact tests were used to determine if APOE4, BDNF Val66Met, or COMT Val158Met are associated with increased psychiatric symptomatology in people with epilepsy. RESULTS As a group, BDNF Met carriers reported greater symptoms of depression on the Personality Assessment Inventory (PAI) than those without a Met allele (p = 0.004); COMT Val carriers reported greater symptoms on the PAI Schizophrenia (p = 0.007), Antisocial Features (p = 0.04), and Alcohol Problems (p = 0.03) scales than noncarriers. On the individual level, a significantly greater proportion of BDNF Met carriers demonstrated elevated PAI Depression scores compared to those without a Met allele (p = 0.046). There was also a larger proportion of COMT Val carriers with elevated PAI Anxiety scores as compared to those without a Val allele (p = 0.036). SIGNIFICANCE This retrospective cross-sectional study provides preliminary evidence for a genetic basis of psychiatric comorbidities in epilepsy and suggests that BDNF and COMT may play an important role in the pathophysiology of mental health problems in this vulnerable population.
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Affiliation(s)
- Christine Doherty
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States of America.
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America.
| | - Darlene P. Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH,Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Jessica B. Altemus
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Imad M. Najm
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland, OH,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America; Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America.
| | - Robyn M. Busch
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH,Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland, OH
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Kumar N, Lhatoo R, Liu H, Colon-Zimmermann K, Tatsuoka C, Chen P, Kahriman M, Sajatovic M. Depressive Symptom Severity in Individuals With Epilepsy and Recent Health Complications. J Nerv Ment Dis 2019; 207:284-290. [PMID: 30865078 PMCID: PMC6526526 DOI: 10.1097/nmd.0000000000000963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Identifying relationships between depression severity and clinical factors may help with appropriate recognition and management of neuropsychiatric conditions in persons with epilepsy (PWE). Demographic characteristics, epilepsy variables, and medical and psychiatric comorbidities were examined from a baseline randomized controlled trial sample of 120 PWE. Among demographic characteristics, only inability to work was significantly associated with depression severity (p = 0.05). Higher 30-day seizure frequency (p < 0.01) and lower quality of life (p < 0.0001) were associated with greater depression severity. Comorbid bipolar disorder (p = 0.02), panic disorder (p < 0.01), and obsessive-compulsive disorder (p < 0.01) were correlated with worse depression severity. The literature supports our findings of correlations between worse depression, seizure frequency, and lower quality of life. Less well studied is our finding of greater depression severity and selected psychiatric comorbidities in PWE.
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Affiliation(s)
- Neha Kumar
- Case Western Reserve University School of Medicine
| | | | - Hongyan Liu
- Department of Neurology and Neurological and Behavioral Outcomes Center
| | | | - Curtis Tatsuoka
- Department of Neurology and Neurological and Behavioral Outcomes Center
| | - Peijun Chen
- Department of Psychiatry, Lois Stokes Cleveland VAMC, and
| | - Mustafa Kahriman
- Department of Neurology, Lois Stokes Cleveland VAMC, Case Western Reserve University School of Medicine
| | - Martha Sajatovic
- Department of Psychiatry and of Neurology, Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Zoppi M, Tedrus GMAS, Laloni DT. Stigma, emotional aspects, and psychological symptoms in individuals with epilepsy. Epilepsy Behav 2019; 93:56-59. [PMID: 30831403 DOI: 10.1016/j.yebeh.2019.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
The relationship between stigma and psychological aspects in adults with epilepsy is poorly studied. The Stigma Scale of Epilepsy (SSE) was related to the Factorial Neuroticism Scale (FNS), Symptoms Assessment Scale-40 (SAS-40), and clinical aspects of 71 individuals with epilepsy, at a significance level of p < 0.05. Clinical and sociodemographic aspects are associated with the presence of psychological symptoms and emotional maladjustment. The occurrence of psychological symptoms in the SAS-40 was associated with uncontrolled seizures, longer illness duration, and perception of greater stigma. There was a relationship between perceived stigma, age, and epilepsy duration. In the linear regression for determining the factors that potentially affected perception of stigma, the symptom dimensions 'somatization' in the SAS-40 (p < 0.001) and the 'psychosocial maladjustment' in the FNS (p = 0.012) were included, and the clinical aspects were excluded. Psychological symptoms were associated with uncontrolled seizures and perceived stigma. Perception of stigma was associated with somatization and psychosocial maladjustment.
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Affiliation(s)
- Mariana Zoppi
- School of Psychology, Pontifícia Universidade Católica de Campinas, Brazil
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Li Q, Chen D, Zhu LN, Wang HJ, Xu D, Tan G, Zhang Y, Liu L. Depression in people with epilepsy in West China: Status, risk factors and treatment gap. Seizure 2019; 66:86-92. [DOI: 10.1016/j.seizure.2019.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 12/18/2022] Open
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Depression predicts interpersonal problems partially through the attitude towards social touch. J Affect Disord 2019; 246:234-240. [PMID: 30584957 DOI: 10.1016/j.jad.2018.12.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/13/2018] [Accepted: 12/16/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Depression is associated with difficulties in interpersonal relationships, of which communication is an integral part. Communication can not only be effected by verbal means, but also non-verbally by touch. Against this background, the aim of the present study was to investigate the relationship between depression, interpersonal problems and the attitude towards social touch. METHODS 147 individuals (115 females; 21-71 years old) seeking treatment in a clinic for outpatient psychotherapy took part in the survey. Three questionnaires evaluating the level of depression (Beck Depression Questionnaire), the degree of interpersonal problems (Inventory of Interpersonal Problems) and the attitude towards social touch (Social Touch Questionnaire, were administered. RESULTS Highly depressed individuals had a more negative attitude towards social touch than non-to lowly depressed individuals. Highly depressed individuals particularly reported to dislike physical touch by not well-known people, but not by close ones. Highly depressed individuals also reported more interpersonal problems, with the level of depression predicting the degree of interpersonal problems. This relationship was partially mediated by the attitude towards social touch in general and, to a greater extent, by the dislike of physical touch by people not well-known in particular. DISCUSSION Given the role of social touch in the relationship between depression and interpersonal problems, the attitude towards touch may be taken into consideration in the therapy of depressed patients. We assume that a more positive attitude towards social touch can influence the ability to create and maintain interpersonal relationships.
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Pellegrino G, Mecarelli O, Pulitano P, Tombini M, Ricci L, Lanzone J, Brienza M, Davassi C, Di Lazzaro V, Assenza G. Eslicarbazepine Acetate Modulates EEG Activity and Connectivity in Focal Epilepsy. Front Neurol 2018; 9:1054. [PMID: 30619030 PMCID: PMC6297144 DOI: 10.3389/fneur.2018.01054] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction: Eslicarbazepine acetate (ESL) is an antiepileptic drug approved as monotherapy or add-on for the treatment of epilepsy with seizures of focal onset. ESL owns a good profile in terms of efficacy and tolerability, but its effects on EEG activity and connectivity are unknown. The purpose of this study was to investigate EEG activity and connectivity changes after ESL treatment in persons with focal epilepsy (PFE). Material and Methods: We performed a multicentre, longitudinal, retrospective, quantitative EEG study on a population of 22 PFE, and a group of 40 controls. We investigated the ESL-related changes of EEG power spectral activity and global connectivity [phase locking value (PLV), amplitude envelope correlation (AEC) and amplitude envelope correlation of orthogonalized signals (Ortho-AEC)] for standard frequency bands (delta to gamma). Seizure frequency was evaluated to assess ESL efficacy in our cohort. Results: ESL significantly enhanced both global power spectral density and connectivity for all frequency bands, similarly for all connectivity measures. When compared to the control group, Post-ESL power was significantly higher in theta and gamma band. Pre-ESL connectivity values were significantly lower than control for all frequency bands. Post-ESL connectivity increased and the gap between the two groups was no longer significant. ESL induced a 52.7 ± 41.1% reduction of seizure frequency, with 55% of clinical responders (reduction of seizures ≥50%). Discussion: ESL therapy induces significant enhancement of brain activity and connectivity. Post-ESL connectivity profile of epilepsy patients was similar to the one of healthy controls.
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Affiliation(s)
| | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Mario Tombini
- Neurology Department, Campus Biomedico University of Rome, Rome, Italy
| | - Lorenzo Ricci
- Neurology Department, Campus Biomedico University of Rome, Rome, Italy
| | - Jacopo Lanzone
- Neurology Department, Campus Biomedico University of Rome, Rome, Italy
| | - Marianna Brienza
- Department of Human Neurosciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Chiara Davassi
- Department of Human Neurosciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | | | - Giovanni Assenza
- Neurology Department, Campus Biomedico University of Rome, Rome, Italy
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Assenza G, Mecarelli O, Lanzone J, Assenza F, Tombini M, Di Lazzaro V, Pulitano P. The ROME (Retrospective Observational Multicenter study on Eslicarbazepine) study: Efficacy and behavioural effects of Eslicarbazepine acetate as adjunctive therapy for adults with partial onset seizures in real life. Seizure 2018; 58:35-40. [PMID: 29649684 DOI: 10.1016/j.seizure.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Eslicarbazepine acetate (ESL) is a third-generation member of the dibenzazepine family approved in 2009 by the European Medicines Agency with the indication of adjunctive therapy in adult people with partial-onset seizures (PPOS). We aimed at assessing the ESL impact on seizure frequency and quality of life in PPOS with a particular attention to sleepiness and depression. METHODS We evaluated 50 adult PPOS (>18 years; 48 ± 14 years-old; 23 males) treated with adjunctive ESL for ≥2months with a retrospective multi-centric design. Clinical files of the last 2 years were reviewed checking for monthly seizure frequency, treatment retention rate, adverse drug reactions (ADRs), concomitant anti-epileptic drugs and behavioural scales for sleepiness (Stanford Sleepiness Scale, SSS, and Epworth Sleepiness Scale, ESS), depression (Beck Depression Inventory-II, BDI) and overall quality of life (QOLIE-31). RESULTS At the end of 96 ± 28 days of ESL treatment, the mean seizure reduction was 56%; 60% of patients had seizure reduction above 50%, with a 31% of the whole population becoming seizure free. We reported 16 ADRs with 4 hyponatremia. Retention rate was 76%. Patient reported less sleepiness after ESL (SSS, p = 0.031; ESS, p = 0.0000002). Before ESL, 38% of patients had pathologic BDI scores, which normalized in most of them (73%) after ESL (BDI improvement, p = 0.000012). These scores resulted in an amelioration of quality of life (QOLIE-31, p = 0.000002). CONCLUSIONS ESL is a safe and effective anti-epileptic drug in a real life scenario, with an excellent behavioural profile for the overall quality of life and, in particular, for sleepiness and depression.
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Affiliation(s)
- G Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - O Mecarelli
- Department of Neurology and Psychiatry, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - J Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - F Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - M Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - V Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - P Pulitano
- Department of Neurology and Psychiatry, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
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Yıldırım Z, Ertem DH, Ceyhan Dirican A, Baybaş S. Stigma accounts for depression in patients with epilepsy. Epilepsy Behav 2018; 78:1-6. [PMID: 29161628 DOI: 10.1016/j.yebeh.2017.10.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Epilepsy is a chronic disease with an increased risk of stigmatization due to psychosocial consequences of the seizures. Intuitively, one may well conclude that stigmatization would lead to depression in patients with epilepsy as well as in other patient groups with increased risk of stigmatization. Indeed, there are a few studies in support of this intuition. In this study, we aimed to investigate the relationship between level of stigmatization and the severity of the depressive symptoms in our patients with epilepsy. METHODS This is a substudy of our main study, which aimed to develop a scale for the quantification of the stigma level in patients with epilepsy. The study included a total of 302 patients with epilepsy, who had at least a literacy level education and one-week-seizure-freedom. Beck Depression Inventory (BDI) was used to quantify depressive symptoms. The correlation between BDI scores and the Stigma Scale for Epilepsy-Self Report (SSE-SR) scores was evaluated. A regression analysis was done in order to parse out significant sociodemographic and clinical factors contributing to depressive symptoms. Statistical analyses were done using the Statistics Package for the Social Sciences software 24.0 package program. RESULTS We saw that 46.9% (n=139) of this population rated themselves as having at least mildly depressive symptoms with BDI (BDI>9). There was a moderate positive correlation between stigma scores and BDI scores (p=0.000, r=0.504), and 96.3% of highly stigmatized patients had at least mildly depressive scores, 73.9% of the nonstigmatized group had none or minimal depressive scores. Stigma scores (β=.51), gender, educational level, seizure frequency, and income level were the variables significantly affecting the BDI scores. Stigma score accounted for 26.2% of the variance in the BDI score. CONCLUSION This study shows that stigmatization of the patients with epilepsy leads to depression in those patients. Therefore, protection of the patients with epilepsy against stigmatization may also help to protect them from a concomitant disabling condition. On the other hand, detection for depressive symptoms in already stigmatized patients with epilepsy may unearth a treatable condition.
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Affiliation(s)
- Zerrin Yıldırım
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Department of Neurology, Istanbul, Turkey; Bagcilar Education and Research Hospital, Department of Neurology, Istanbul, Turkey.
| | - Devrimsel Harika Ertem
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Algology, Istanbul, Turkey
| | - Ayten Ceyhan Dirican
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Sevim Baybaş
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Department of Neurology, Istanbul, Turkey
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Sarrouilhe D, Dejean C, Mesnil M. Connexin43- and Pannexin-Based Channels in Neuroinflammation and Cerebral Neuropathies. Front Mol Neurosci 2017; 10:320. [PMID: 29066951 PMCID: PMC5641369 DOI: 10.3389/fnmol.2017.00320] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022] Open
Abstract
Connexins (Cx) are largely represented in the central nervous system (CNS) with 11 Cx isoforms forming intercellular channels. Moreover, in the CNS, Cx43 can form hemichannels (HCs) at non-junctional membrane as does the related channel-forming Pannexin1 (Panx1) and Panx2. Opening of Panx1 channels and Cx43 HCs appears to be involved in inflammation and has been documented in various CNS pathologies. Over recent years, evidence has accumulated supporting a link between inflammation and cerebral neuropathies (migraine, Alzheimer’s disease (AD), Parkinson’s disease (PD), major depressive disorder, autism spectrum disorder (ASD), epilepsy, schizophrenia, bipolar disorder). Involvement of Panx channels and Cx43 HCs has been also proposed in pathophysiology of neurological diseases and psychiatric disorders. Other studies showed that following inflammatory injury of the CNS, Panx1 activators are released and prolonged opening of Panx1 channels triggers neuronal death. In neuropsychiatric diseases, comorbidities are frequently present and can aggravate the symptoms and make therapeutic management more complex. The high comorbidity between some neuropathies can be partially understood by the fact that these diseases share a common etiology involving inflammatory pathways and Panx1 channels or Cx43 HCs. Thus, anti-inflammatory therapy opens perspectives of targets for new treatments and could have real potential in controlling a cerebral neuropathy and some of its comorbidities. The purpose of this mini review is to provide information of our knowledge on the link between Cx43- and Panx-based channels, inflammation and cerebral neuropathies.
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Affiliation(s)
- Denis Sarrouilhe
- Laboratoire de Physiologie Humaine, Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
| | - Catherine Dejean
- Service Pharmacie, Pavillon Janet, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Marc Mesnil
- STIM Laboratory, ERL 7368-CNRS, Université de Poitiers, Pôle Biologie Santé, Poitiers, France
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The Unforgettable Neurosurgical Operations of Musicians in the Last Century. World Neurosurg 2017; 101:444-450. [DOI: 10.1016/j.wneu.2016.11.144] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/26/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022]
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