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Becker C, Mancic A, Ghestem A, Poillerat V, Claverie D, Bartolomei F, Brouillard F, Benoliel JJ, Bernard C. Antioxidant treatment after epileptogenesis onset prevents comorbidities in rats sensitized by a past stressful event. Epilepsia 2019; 60:648-655. [PMID: 30866060 DOI: 10.1111/epi.14692] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Unresolved past stressful events can induce a state of vulnerability to epilepsy and comorbidities. Using an experimental model of stress-induced vulnerability to depression, we tested whether an antioxidant treatment applied after the onset of epileptogenesis was disease modifying and could prevent the occurrence of comorbidities. METHODS We used social defeat (SD) to trigger a state of vulnerability in half of the SD-exposed population of rats. One month after SD, we used repeated injections of kainic acid to trigger status epilepticus (SE). One subset of animals was treated after SE during 2 weeks with Tempol, a strong antioxidant. Supradural 24/7 recordings were used to assess the development of epilepsy. We assessed spatial and nonspatial memory as well as a depressionlike profile 6 weeks after SE. RESULTS Serum brain-derived neurotrophic factor (BDNF) levels decreased after SD in all animals and recovered to pre-SD levels 1 month later in half of them (SDN group). The other half kept low serum BDNF levels (SDL group). At that stage, SDN and SDL animals do not present a depressionlike profile. The SDL group was more sensitive than the SDN group to epileptogenic conditions. Following SE, the SDL group displayed accelerated epileptogenesis, a depressionlike profile, and severe cognitive deficits as compared to SDN rats. Transient Tempol treatment was disease-modifying, reducing the number of seizures, and prevented the development of comorbidities in the SDL group. Tempol treatment normalized oxidative stress in the SDL group to SDN levels. SIGNIFICANCE This study illustrates the disease-modifying effect of antioxidant treatment after the onset of epileptogenesis in a population rendered vulnerable by past stressful events. The transient treatment decreased seizure burden and had long-term effects, preventing the occurrence of a depressionlike profile and cognitive deficits. We propose that vulnerability to comorbidities can be reversed after the onset of epilepsy.
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Affiliation(s)
- Christel Becker
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Angelina Mancic
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Antoine Ghestem
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
| | - Victoria Poillerat
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Damien Claverie
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France.,Institut de Recherche Biomédicale des Armées (IRBA), Brétigny sur Orge, France
| | - Fabrice Bartolomei
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France.,Service de Neurophysiologie Clinique, CHU Timone AP-HM, Marseille, France
| | - Franck Brouillard
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Jean-Jacques Benoliel
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France.,Service de Biochimie Endocrinienne et Oncologique, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Christophe Bernard
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
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Ho NT, Kroner B, Grinspan Z, Fureman B, Farrell K, Zhang J, Buelow J, Hesdorffer DC. Comorbidities of Rare Epilepsies: Results from the Rare Epilepsy Network. J Pediatr 2018; 203:249-258.e5. [PMID: 30195559 DOI: 10.1016/j.jpeds.2018.07.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/18/2018] [Accepted: 07/12/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe the prevalence and characteristics of comorbidities in persons with rare epilepsies. STUDY DESIGN Persons with rare epilepsies and caregivers of those affected were recruited through the Epilepsy Foundation and more than 30 rare epilepsy advocacy organizations affiliated with the Rare Epilepsy Network (REN). A web-based survey was conducted using a questionnaire consisting of core sections to collect data from affected persons on various aspects, including comorbidities. Comorbidity information was grouped into 15 classes, 12 of which had a stem question followed by detailed branch questions and 3 that were created from a combination of related questions. RESULTS Of 795 persons with more than 30 different rare epilepsy diagnosis groups, one-half had ≥5 comorbidity classes and 97% were classified as complex chronic disease (C-CD). The highest number of comorbidity classes reported per person were persons with Aicardi syndrome, Phelan-McDermid syndrome (median, 7.0; IQR, 5.0-9.0), and tuberous sclerosis complex (median, 6.0; IQR, 4.0-8.0). The most common comorbidity classes were learning/developmental disability (71%), mental health issues (71%), sleep disorders (60%), brain abnormalities (52%), oral issues (49%), bone-joint issues (42%), hyper/hypotonia (42%), and eye-vision disorders (38%). The prevalence of brain abnormalities, hyper/hypotonia, eye, and cardiac disorders was significantly higher in persons first diagnosed with epilepsy at a younger age (<9 months) than in those first diagnosed at an older age (P < .05 for trend). CONCLUSIONS Nearly all persons with rare epilepsies are medically complex, with a high prevalence of multiple comorbidities, especially those who were diagnosed with epilepsy in the first year of life. Comorbidities should be carefully considered in the diagnosis and management of persons with rare epilepsies.
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Affiliation(s)
- Nhan Thi Ho
- Gertrude H. Sergievsky Center, Department of Epidemiology, Columbia University, New York, NY
| | - Barbara Kroner
- Department of Epidemiology, Research Triangle Institute, Research Triangle Park, NC
| | | | - Brandy Fureman
- Research and New Therapies, Epilepsy Foundation, Landover, MD
| | | | - Jingzhou Zhang
- Gertrude H. Sergievsky Center, Department of Epidemiology, Columbia University, New York, NY
| | - Janice Buelow
- Indiana University School of Nursing, Indianapolis, IN
| | - Dale C Hesdorffer
- Gertrude H. Sergievsky Center, Department of Epidemiology, Columbia University, New York, NY.
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Iyengar SS, LaFrancois JJ, Friedman D, Drew LJ, Denny CA, Burghardt NS, Wu MV, Hsieh J, Hen R, Scharfman HE. Suppression of adult neurogenesis increases the acute effects of kainic acid. Exp Neurol 2015; 264:135-49. [PMID: 25476494 PMCID: PMC4800819 DOI: 10.1016/j.expneurol.2014.11.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 11/10/2014] [Accepted: 11/20/2014] [Indexed: 01/17/2023]
Abstract
Adult neurogenesis, the generation of new neurons in the adult brain, occurs in the hippocampal dentate gyrus (DG) and the olfactory bulb (OB) of all mammals, but the functions of these new neurons are not entirely clear. Originally, adult-born neurons were considered to have excitatory effects on the DG network, but recent studies suggest a net inhibitory effect. Therefore, we hypothesized that selective removal of newborn neurons would lead to increased susceptibility to the effects of a convulsant. This hypothesis was tested by evaluating the response to the chemoconvulsant kainic acid (KA) in mice with reduced adult neurogenesis, produced either by focal X-irradiation of the DG, or by pharmacogenetic deletion of dividing radial glial precursors. In the first 4 hrs after KA administration, when mice have the most robust seizures, mice with reduced adult neurogenesis had more severe convulsive seizures, exhibited either as a decreased latency to the first convulsive seizure, greater number of convulsive seizures, or longer convulsive seizures. Nonconvulsive seizures did not appear to change or they decreased. Four-21 hrs after KA injection, mice with reduced adult neurogenesis showed more interictal spikes (IIS) and delayed seizures than controls. Effects were greater when the anticonvulsant ethosuximide was injected 30 min prior to KA administration; ethosuximide allows forebrain seizure activity to be more easily examined in mice by suppressing seizures dominated by the brainstem. These data support the hypothesis that reduction of adult-born neurons increases the susceptibility of the brain to effects of KA.
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Affiliation(s)
- Sloka S Iyengar
- Center for Dementia Research, The Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - John J LaFrancois
- Center for Dementia Research, The Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Daniel Friedman
- Department of Neurology, New York University Langone Medical Center, New York, NY 10016
| | - Liam J Drew
- WIBR, University College of London, London, UK WC1E 6BT
| | - Christine A Denny
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032
| | - Nesha S Burghardt
- Department of Psychology, Hunter College, City University of New York, New York, NY 10065
| | - Melody V Wu
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032
| | - Jenny Hsieh
- Department of Molecular Neurobiology, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - René Hen
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032; Department of Molecular Neurobiology, University of Texas Southwestern Medical Center, Dallas, TX 75390; New York State Psychiatric Institute, New York, NY 10032
| | - Helen E Scharfman
- Center for Dementia Research, The Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962; Departments of Child & Adolescent Psychiatry, Physiology & Neuroscience, and Psychiatry, New York University Langone Medical Center, New York, NY 10016.
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Substance use disorders and psychotic disorders in epilepsy: a population-based registry study. Epilepsy Res 2014; 108:1435-43. [PMID: 25062893 DOI: 10.1016/j.eplepsyres.2014.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/12/2014] [Accepted: 06/13/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Epilepsy affects around 70 million people worldwide. Psychiatric comorbidity may add to the burden of the disease. We studied substance use disorders and psychotic disorders among people with epilepsy from a population-based perspective. METHODS Norwegian specialist health services (hospitals and outpatient clinics) report diagnoses for individual patients to the Norwegian Patient Register. We used information on subjects born in 1930-1994 who were registered with a diagnosis of epilepsy at least once during the five-year period of 2008-2012. We compared the proportion of people with epilepsy registered with substance use disorders (alcohol use disorders or non-alcohol drug use disorders) and psychotic disorders (schizophrenia spectrum disorders or bipolar disorder) with similar figures in the population without epilepsy. We applied chi-square tests and log-binomial regression for analysis. RESULTS Overall, 0.90% of the Norwegian adult population was registered with epilepsy in somatic hospitals during 2008-2012. The total proportion registered with alcohol use disorder was 5.74% among people with epilepsy and 1.29% in the population without epilepsy (age- and sex-adjusted relative risk [RR]: 4.42, 95% confidence interval [CI]: 4.22-4.62). The corresponding figures were 4.32% and 1.22% (RR 3.86 [95% CI: 3.67-4.06] for drug use disorder, 1.72% and 0.60% (RR 2.94 [95% CI: 2.71-3.19]) for schizophrenia spectrum disorders, and 1.50% and 0.68% (RR 2.29 [95% CI: 2.10-2.49]) for bipolar disorder. CONCLUSION People with epilepsy were more often registered with substance use disorders and psychotic disorders than people without epilepsy. Psychiatric comorbidity requires particular attention in both diagnostic work-up and management of epilepsy, and creates complex medical challenges that require close cooperation between neurologists and psychiatrists. These findings may have implications for the organization and further development of comprehensive epilepsy care.
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Kapfhammer HP. [Coexistent depressive and anxiety disorders in epilepsy and multiple sclerosis: a challenge to neuropsychiatric practice]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2014; 28:142-50. [PMID: 24841901 DOI: 10.1007/s40211-014-0105-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/01/2014] [Indexed: 01/10/2023]
Abstract
The high rate of co-existent emotional disorders in major neurological disorders, such as epilepsy and multiple sclerosis is challenging. As a rule, this co-existence comprises a more dramatic subjective suffering, a reduced psychological coping, possible negative interferences with somatic treatments and rehabilitations, an impaired quality of life and higher grades of psychosocial disability. It may also lead to an overall increased risk of somatic morbidity and even mortality in the further course of illness. These complex interrelations may be favourably integrated within a biopsychosocial model. Psychological and psychosocial stressors can be appreciated on their own discrete levels, have to be reflected, however, in their neurobiological correlates. Both neurological and emotional disorders frequently share decisive pathogenetic mechanisms, i.e. the underlying process of neurological disease may contribute to major affective problems also in a somato-psychic direction. In addition, mutual interactions of both neurological and psychiatric treatments in their impact on the emotional and neurological risks have to be appreciated.
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Affiliation(s)
- Hans-Peter Kapfhammer
- Klinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich,
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