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Hernandez Poblete N, Gay F, Salvo F, Micoulaud-Franchi JA, Bienvenu T, Coelho J, Aupy J. Resective epilepsy surgery and its impact on depression in adults: a systematic review, meta-analysis, and implications for future research. J Neurol Neurosurg Psychiatry 2024; 95:956-965. [PMID: 38443157 DOI: 10.1136/jnnp-2023-333073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND How epilepsy surgery influences the bidirectional relationship of epilepsy and depression remains poorly defined. METHOD For a better understanding of this question, we conducted a systematic review and meta-analysis of risk ratio on depression prevalence before and after epilepsy surgery, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Three databases were comprehensively screened for all studies assessing depression before and after resective surgery in adult epileptic patients until 8 October 2022. Studies were included if depression was assessed before and after epilepsy surgery regardless of the time of follow-up. A total of 1917 studies were screened for eligibility and 91 full-texts up for inclusion; 35 studies were finally included, 25 studies and 2563 patients were included in main meta-analysis and 10 for exploratory analysis. Risk of bias was assessed using Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) from Cochrane. To derive the pooled depression rates before and after surgery, a meta-analysis with inversed-variance was performed using random-effects logistic models with Peto's correction and a 95% CI. Heterogeneity was assessed with Cochran's Q-test along with its derived measure of inconsistency I2. RESULTS Overall, the depression rates before and after resective epilepsy surgery were 0.70 (0.53 to 0.91) 95% CI, suggesting that the rate of depression at last follow-up evaluation tends to decrease after Resective Epilepsy Surgery (RES). Subgroup analysis suggest a positive long-term effect appears with a significant lower rates of depression already 6 months (0.61 (0.38 to 0.98)), after surgery which is maintained over time after 1 year (0.53 (0.31 to 0.90)), and after 2 years (0.62 (0.42 to 0.92)). CONCLUSION This important finding should be taken in consideration before resective surgery for drug-resistant epilepsies. However, prospective studies should be conducted to characterise which patient, at the individual level, might be at risk of de novo or worsening of depression. PROSPERO REGISTRATION NUMBER CRD42022355386.
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Affiliation(s)
| | - Florian Gay
- CERPAD, CH Charles Perrens, Bordeaux, Aquitaine, France
| | - Francesco Salvo
- INSERM, Pharmaco-epidemiology Team, Université de Bordeaux, Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- Clinical Neurosciences, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
- CNRS, SANPSY, Université de Bordeaux, Bordeaux, France
| | - Thomas Bienvenu
- CERPAD, CH Charles Perrens, Bordeaux, Aquitaine, France
- INSERM, Neurocentre Magendie, Université de Bordeaux, Bordeaux, France
| | - Julien Coelho
- Clinical Neurosciences, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
| | - Jerome Aupy
- Clinical Neurosciences, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
- CNRS, IMN, Université de Bordeaux, Bordeaux, France
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Maria de Araujo Filho G, Teixeira AL. Management of anhedonia after epilepsy surgery. Epilepsy Behav Rep 2024; 26:100658. [PMID: 38495401 PMCID: PMC10940138 DOI: 10.1016/j.ebr.2024.100658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Anhedonia is clinically defined as difficulty or inability to feel pleasure or to be motivated to perform activities that were previously pleasurable. Anhedonia is a core feature of depressive disorders but can be present in other conditions such as substance use and anxiety disorders. Herein we report the case of a 34-year-old female who developed marked anhedonia after left cortico-amygdalohippocampectomy. Despite optimal seizure control, the person struggled with anhedonia and other depressive symptoms. After ruling out medico-neurologic complications, she was prescribed with a selective serotonin reuptake inhibitor and cognitive-behavioral therapy. Anhedonia can be a challenging neuropsychiatric presentation that requires ruling out the effects of antiseizure medications, neurosurgery, and other drugs before prescribing antidepressants.
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Affiliation(s)
- Gerardo Maria de Araujo Filho
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Antonio L. Teixeira
- Faculdade Santa Casa BH, Belo Horizonte, Brazil
- Biggs Institute, The University of Texas Health Science Center at San Antonio (UT Health San Antonio), San Antonio, TX, United States
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Mula M. Impact of psychiatric comorbidities on the treatment of epilepsies in adults. Expert Rev Neurother 2023; 23:895-904. [PMID: 37671683 DOI: 10.1080/14737175.2023.2250558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Epilepsy is often accompanied by psychiatric comorbidities and the management of epilepsy in these patients presents unique challenges due to the interplay between the underlying neurological condition and the psychiatric symptoms and the combined use of multiple medications. AREAS COVERED This paper aims to explore the complexities associated with managing epilepsy in the presence of psychiatric comorbidities, focusing on the impact of psychiatric disorders on epilepsy treatment strategies and the challenges posed by the simultaneous administration of multiple medications. EXPERT OPINION Patients with epilepsy and psychiatric comorbidities seem to present with a more severe form of epilepsy that is resistant to drug treatments and burdened by an increased morbidity and mortality. Whether prompt treatment of psychiatric disorders can influence the long-term prognosis of the epilepsy is still unclear as well as the role of specific treatment strategies, such as neuromodulation, in this group of patients. Clinical practice recommendations and guidelines will prompt the development of new models of integrated care to be implemented.
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Affiliation(s)
- Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK of Great Britain and Northern Ireland
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Ploesser M, McDonald C, Hirshman B, Ben-Haim S. Psychiatric outcomes after temporal lobe surgery in patients with temporal lobe epilepsy and comorbid psychiatric illness: A systematic review and meta-analysis. Epilepsy Res 2023; 189:107054. [PMID: 36473277 DOI: 10.1016/j.eplepsyres.2022.107054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/05/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The currently available evidence is unclear in regard to psychiatric outcomes of temporal lobe epilepsy (TLE) in patients with comorbid psychiatric disorders (PD). AIM To identify and synthesize psychiatric outcomes in patients with TLE and comorbid psychiatric illnesses before and after TLE surgery. METHODS Studies were included if participants were adults and/or children with temporal epilepsy and comorbid psychiatric illness. Surgical interventions included focal resection (e.g., lobectomy, selective amygdalohippocampectomy) or stereotactic laser ablation. Included studies reported on pre- and post- surgery data of comorbid psychiatric illness (e.g., mood and anxiety disorders, depression, psychosis, adjustment disorders, non-epileptic seizures, and personality disorders). RESULTS Ten studies were included in the review. The proportion of patients achieving PD resolution or improvements after surgery varied widely between studies, ranging from 15 % to 57 % at the reported follow-up time. Three studies reported on PD symptom worsening after surgery, with considerable variations of patient proportions across studies. Meta-analysis suggests that 43 % of patients demonstrated improvement and 33 % of patients showed a worsening in psychiatric scores across all studies. Preliminary data from three studies suggest that seizure control may be associated with favourable psychiatric outcomes. CONCLUSION A considerable proportion of reported TLE patients with comorbid psychiatric illnesses have improvement in their psychiatric symptoms after temporal lobe epilepsy surgery. There is scarcity of detailed outcome reporting including symptom scores, and to date, predictive factors for favourable vs unfavourable outcomes in this patient population are not clear. Further research on the topic is warranted.
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Affiliation(s)
- Markus Ploesser
- Department of Psychiatry & Neuroscience, UC Riverside School of Medicine, 900 University Ave. Riverside, CA 92521, USA; University of British Columbia, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver BC V6T 2A1, Canada.
| | - Carrie McDonald
- Department of Psychiatry, University of California San Diego, 9500 Gillman Drive, La Jolla, CA 92093, USA
| | - Brian Hirshman
- Department of Neurological Surgery, University of California San Diego, 9300 Campus Point Drive, La Jolla, CA 92037, USA
| | - Sharona Ben-Haim
- Department of Neurological Surgery, University of California San Diego, 9300 Campus Point Drive, La Jolla, CA 92037, USA
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Steriade C. Bringing Statistics to the Clinic to Predict the Future: Nomograms for Psychiatric Outcomes of Epilepsy Surgery. Epilepsy Curr 2021; 21:337-338. [PMID: 34924828 PMCID: PMC8655253 DOI: 10.1177/15357597211029183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Camargo Camargo L, Tejada Angarita KS, Suarez Marín MM, Fandiño Franky J. Psychiatric alterations after previous temporal lobectomy: Report of cases and review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 50:301-307. [PMID: 34742698 DOI: 10.1016/j.rcpeng.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 05/25/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
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Affiliation(s)
- Loida Camargo Camargo
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia.
| | | | | | - Jaime Fandiño Franky
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia
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Benevides ML, Costa Nunes J, Guarnieri R, Melo H, Lunardi M, Neves Linhares M, Kupek E, Wolf P, Lin K, Walz R. Anxiety and depressive symptoms long after mesial temporal epilepsy surgery: A prospective study. Epilepsy Behav 2021; 118:107936. [PMID: 33839452 DOI: 10.1016/j.yebeh.2021.107936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anxiety and depressive symptoms are prevalent in patients with refractory mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) before and after anterior temporal lobectomy (ATL). AIMS (1) To follow the levels of anxiety and depressive symptoms long-term after ATL among patients with refractory MTLE-HS; (2) To identify pre- and postsurgical variables associated with the levels of anxiety and depressive symptoms after surgery. METHODS We compared the levels of anxiety and depressive symptoms determined by the Hospital Anxiety and Depression Scale (HADS) before and long after ATL (mean 104 months, range 70-130) in 41 consecutive patients refractory MTLE-HS. The last follow-up was between September 2018 and March 2020. We also determined pre- and postsurgical variables independently associated with the HADS scores after surgery. RESULTS The scores of HADS and its subdomains related to anxiety and depression decreased significantly (p < 0.01) after ATL. After multiple linear regressions, the HADS-Anxiety scores before surgery (B = 0.47, CI 95% 0.20 to 0.75, p = 0.001) and at follow-up after surgery (B = 0.07, CI 0.00 to 0.14, p = 0.05) remain independently and positively associated with HADS-Anxiety scores after surgery. The HADS-Depression scores after surgery were independently positively associated with HADS-Depression scores before surgery (B = 0.39, CI 95% 0.10 to 0.76, p = 0.01) and worse seizure control after surgery (B = 1.55, CI 95% 0.23 to 2.87, p = 0.02). CONCLUSION Anxiety and depressive symptoms in patients with MTLE-HS significantly improved after ATL. Presurgical levels of anxiety and depressive symptoms, respectively, were positively associated with the postsurgical levels of those symptoms. Length of follow-up is associated with anxiety, and worse seizure control is associated with depressive symptoms after ATL. The results have implications for the surgical management of MTLE-HS patients.
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Affiliation(s)
- Maria Luiza Benevides
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil.
| | - Jean Costa Nunes
- Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Division of Neuropathology, HU, UFSC, Florianópolis, SC, Brazil; Neurodiagnostic Brasil - Diagnósticos em Neuropatologia, Florianópolis, SC, Brazil; Psychiatry Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil
| | - Ricardo Guarnieri
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil
| | - Hiago Melo
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil
| | - Mariana Lunardi
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marcelo Neves Linhares
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurosurgery Division, Surgery Department, HU, UFSC, Florianópolis, Brazil; Neurosurgery Service, Governador Celso Ramos Hospital, Florianópolis, Brazil
| | - Emil Kupek
- Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Departament of Public Health, UFSC, Florianópolis, SC, Brazil
| | - Peter Wolf
- Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
| | - Kátia Lin
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
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Sobregrau P, Andreu C, Carreño M, Donaire A, Rumià J, Boget T, Bargalló N, Setoain X, Roldan P, Conde-Blanco E, Centeno M, Pintor L. Psychiatric disorders in patients with resistant temporal lobe epilepsy two years after undergoing elective surgery. A longitudinal study. Epilepsy Behav 2021; 118:107921. [PMID: 33831648 DOI: 10.1016/j.yebeh.2021.107921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Psychiatric morbidity in temporal lobe epilepsy (TLE) is frequent and negatively affects patients' life quality. Surgery is the procedure of choice when treating seizures, although the effects on psychiatric disorders remain unclear. We evaluate the effect of surgery on psychiatric disorders in patients with TLE two years after the intervention, to then shed light on how these are related to anxiety and depression symptoms, and Interictal Dysphoric Disorder (IDD). METHODS We included data from 65 patients with TLE whose psychiatric evaluations were performed according to DSM-IV criteria. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) test. RESULTS At 2-year follow-up, anxiety and depressive disorders decreased, and psychotic disorders augmented without statistical significance. Baseline psychiatric disorders predisposed to psychiatric pathology at 2-year follow-up and did not correlate with epilepsy outcome after surgery. Postoperative psychiatric disorders correlated with the seizure incidence two years after the intervention, suggesting that epilepsy and psychiatric disorders were associated in processes such as surgery. De novo psychiatric disorders represented 52% of postoperative psychiatric pathology, 62% being psychotic disorders. De novo psychiatric disorders became more frequent from the first year of surgery, occurring mainly in patients free of seizures. The HADS test scores and IDD correlated with psychiatric disorders at 2-year follow-up. CONCLUSIONS Baseline psychiatric disorders did not influence surgery outcome, but correlated with psychiatric disorders' prevalence two years after surgery. Despite not finding statistical significance, surgery reduced the prevalence of psychiatric disorders, and de novo psychiatric disorders were associated with an improvement in the epilepsy course at 2-year follow-up.
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Affiliation(s)
- Pau Sobregrau
- Department of Psychiatry, Hospital Clinic of Barcelona, Barcelona 08036, Spain; University of Barcelona (UB), Barcelona 08007, Spain
| | | | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Núria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Pedro Roldan
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Estefanía Conde-Blanco
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Program, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - María Centeno
- Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Luís Pintor
- Department of Psychiatry, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain.
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Teixeira AL. Peri-Ictal and Para-Ictal Psychiatric Phenomena: A Relatively Common Yet Unrecognized Disorder. Curr Top Behav Neurosci 2021; 55:171-181. [PMID: 33728598 DOI: 10.1007/7854_2021_223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with epilepsy can experience different neuropsychiatric symptoms related (peri-ictal) or not (interictal) with seizures. Peri-ictal symptoms can precede (pre-ictal) or follow (post-ictal) the seizure, or even be the expression of the seizure activity (ictal). Neuropsychiatric symptoms, such as irritability and apathy, are among the most frequent pre-ictal manifestations. Ictal fear is reported by around 10% of patients with focal seizures, and sometimes can be difficult to differentiate from panic attacks. Post-ictal anxiety, mood and psychotic symptoms are also frequently reported by patients. Peri-ictal phenomena can occur as isolated symptom or as a cluster of symptoms, sometimes resembling a full-blown psychiatric syndrome. Actually, peri-ictal and interictal neuropsychiatric manifestations seem to be closely associated.
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Affiliation(s)
- Antonio Lucio Teixeira
- Instituto de Ensino e Pesquisa, Santa Casa BH, Belo Horizonte, Brazil. .,Neuropsychiatry Program, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, UTHealth Houston, Houston, TX, USA.
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Doherty C, Nowacki AS, Pat McAndrews M, McDonald CR, Reyes A, Kim MS, Hamberger M, Najm I, Bingaman W, Jehi L, Busch RM. Predicting mood decline following temporal lobe epilepsy surgery in adults. Epilepsia 2021; 62:450-459. [PMID: 33464568 DOI: 10.1111/epi.16800] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a model to predict the probability of mood decline in adults following temporal lobe resection for the treatment of pharmacoresistant epilepsy. METHODS Variable selection was performed on 492 patients from the Cleveland Clinic using best subsets regression. After completing variable selection, a subset of variables was requested from four epilepsy surgery centers across North America (n = 100). All data were combined to develop a final model to predict postoperative mood decline (N = 592). Internal validation with bootstrap resampling was performed. A clinically significant increase in depressive symptoms was defined as a 15% increase in Beck Depression Inventory-Second Edition score and a postoperative raw score > 11. RESULTS Fourteen percent of patients in the Cleveland Clinic cohort and 22% of patients in the external cohort experienced clinically significant increases in depressive symptoms following surgery. The final prediction model included six predictor variables: psychiatric history, resection side, relationship status, verbal fluency score, age at preoperative testing, and presence/absence of malformation of cortical development on magnetic resonance imaging. The model had an optimism-adjusted c-statistic of .70 and good calibration, with slight probability overestimation in higher risk patients. SIGNIFICANCE Clinicians can utilize our nomogram via a paper tool or online calculator to estimate the risk of postoperative mood decline for individual patients prior to temporal lobe epilepsy surgery.
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Affiliation(s)
- Christine Doherty
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Amy S Nowacki
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Pat McAndrews
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Carrie R McDonald
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Anny Reyes
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Michelle S Kim
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Marla Hamberger
- Department of Neurology, Columbia University, New York, New York, USA
| | - Imad Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Bingaman
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lara Jehi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Can We Anticipate and Prevent the Occurrence of Iatrogenic Psychiatric Events Caused by Anti-seizure Medications and Epilepsy Surgery? Curr Top Behav Neurosci 2021; 55:281-305. [PMID: 33860467 DOI: 10.1007/7854_2021_228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Psychiatric disorders and behavioral manifestations in patients with epilepsy have complex and multifactorial etiologies. The psychotropic properties of anti-seizure medications (ASMs) and psychiatric effects of epilepsy surgery can result in iatrogenic psychiatric symptoms or episodes or can yield a therapeutic effect of underlying psychiatric disorders and have a significant impact on the patients' quality of life. The aims of this chapter are to review the available evidence of psychotropic properties of ASMs, which may be responsible for iatrogenic psychiatric symptoms and/or disorders. Moreover, the several aspects associated with the impact of epilepsy surgery on the possible improvement/development of psychiatric disorders were addressed.
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Camargo Camargo L, Tejada Angarita KS, Suarez Marin MM, Fandiño Franky J. Psychiatric Alterations after Previous Temporal Lobectomy: Report of Cases and Review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 50:S0034-7450(20)30066-4. [PMID: 33735060 DOI: 10.1016/j.rcp.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/05/2020] [Accepted: 05/25/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
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Affiliation(s)
- Loida Camargo Camargo
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia.
| | | | | | - Jaime Fandiño Franky
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia
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Wang Y, Hou D, Wu X, Qiu L, Chen H, Xin J, Yan Z, Sun M. An intensive education program for caregivers ameliorates anxiety, depression, and quality of life in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis who underwent cortico-amygdalohippocampectomy. Braz J Med Biol Res 2020; 53:e9000. [PMID: 32696820 PMCID: PMC7372948 DOI: 10.1590/1414-431x20209000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to investigate the effect of a caregiver intensive education
program (CIEP) on anxiety, depression, and quality of life (QOL) in patients
with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis
(TLE-MTS) who underwent cortico-amygdalohippocampectomy (CAH). Ninety patients
with drug-resistant TLE-MTS who underwent CAH and their caregivers were
recruited and randomly allocated to the CIEP group or control group as 1:1
ratio. Caregivers received the CIEP program or routine guidance/education
(control group). Anxiety/depression and QOL in patients at month (M)0, M1, M3,
and M6 were assessed by the Hospital Anxiety and Depression Scale (HADS) scale
and the QOL in Epilepsy Inventory-31 (QOLIE-31), respectively. Treatment
efficacy at M6 was assessed by Engel classification. The HADS-anxiety score at
M3 (P=0.049) and M6 (P=0.028), HADS-anxiety score change (M6-M0) (P=0.001),
percentage of anxiety patients at M6 (P=0.025), and anxiety severity at M6
(P=0.011) were all decreased in the CIEP group compared with the control group.
The HADS-depression score at M6 (P=0.033) and HADS-depression score change
(M6-M0) (P=0.022) were reduced, while percentage of depression patients at M6
(P=0.099) and depression severity at M6 (P=0.553) showed no difference in the
CIEP group compared with the control group. The QOLIE-31 score at M6 (P=0.043)
and QOLIE-31 score change (M6-M0) (P=0.010) were both elevated in the CIEP group
compared with the control group. In conclusion, CIEP for caregivers contributed
to the recovery of anxiety and depression as well as the improvement of QOL in
patients with drug-resistant TLE-MTS who underwent CAH.
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Affiliation(s)
- Yuena Wang
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongyu Hou
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaohua Wu
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lili Qiu
- Department of Endocrinology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Chen
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianxia Xin
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhirong Yan
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Meiling Sun
- Department of Nursing, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
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MacDonald KE, Cozza KL, Vythilingam M. Epilepsy-Related Psychosis: A Case Report and Brief Review of Literature. PSYCHOSOMATICS 2019; 61:400-404. [PMID: 31836195 DOI: 10.1016/j.psym.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Kelly E MacDonald
- Department of Behavioral Health, United States Army Medical Activity, Fort Drum, NY.
| | - Kelly L Cozza
- Department of Psychiatry, Uniformed Services University, and Walter Reed National Military Medical Center, Bethesda, MD
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Brandalise MH, de Araujo Filho GM, Centeno RS, Yacubian EMT, Jackowski AP. Effects of a brief psychotherapeutic intervention on resilience and behavior in patients with drug-resistant mesial temporal lobe epilepsy and late seizure recurrence after surgery. Epilepsy Behav 2019; 100:106512. [PMID: 31574426 DOI: 10.1016/j.yebeh.2019.106512] [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: 07/10/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 11/15/2022]
Abstract
Seizure recurrence (SR) after epilepsy surgery in patients with medically resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) can compromise medical treatment and quality of life (QOL). However, there is a scarcity of interventions specifically addressing this issue in the literature. We aimed to evaluate the impact of a four-week psychotherapeutic intervention on the levels of resilience, behavioral symptoms, and QOL of patients with drug-resistant TLE-MTS who underwent corticoamygdalohippocampectomy (CAH) and who presented with late SR. Fifty patients who had been diagnosed with TLE-TMS, undergone CAH, and presented with late SR were included. The study instruments included a clinical and sociodemographic questionnaire and the Brazilian versions of the Connor-Davidson Resilience Scale (CD-RISC-10), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Interictal Dysphoric Disorder Inventory (IDDI), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Significant reductions in the IDDI (p < 0.001) and NDDI-E (p < 0.001) scores, improvements in the CD-RISC-10 (p < 0.001) and QOLIE-31 (p < 0.001) scores, and positive correlations between resilience levels and QOL (p < 0.01), as well as a negative correlation between depressive symptoms and resilience (p < 0.01) and QOL (p < 0.01), were observed after the psychotherapeutic intervention. Improvements in the resilience levels and QOL, with concomitant reductions in depressive symptoms, were observed in patients with TLE-MTS and late SR after a brief psychotherapeutic intervention. Since there is a lack of studies that measured the impact of interventions in this patient subpopulation, these results may support the development of treatment strategies for this specific group.
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Affiliation(s)
| | - Gerardo Maria de Araujo Filho
- Universidade Federal de Sao Paulo (UNIFESP), Department of Psychiatry, Brazil; Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Department of Psychiatry and Medical Psychology, Brazil.
| | - Ricardo Silva Centeno
- Universidade Federal de Sao Paulo (UNIFESP), Department of Neurology and Neurosurgery, Brazil
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Novais F, Pestana LC, Loureiro S, Andrea M, Figueira ML, Pimentel J. Psychiatric disorders as predictors of epilepsy surgery outcome. Epilepsy Behav 2019; 100:106513. [PMID: 31639645 DOI: 10.1016/j.yebeh.2019.106513] [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: 03/05/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Our aim was to determine if a history of a mental disorder predicts a worst neurological outcome for patients undergoing epilepsy surgery. METHODS We conducted an ambispective observational study including people with refractory epilepsy who underwent resective surgery. Demographic, psychiatric, and neurological data were collected, before and one year after surgery. Presurgical interviews included a psychiatric evaluation and the determination of prevalent and lifetime psychiatric diagnosis. The one-year postsurgical outcome was classified according to the Engel Outcome Scale. Predictors of postsurgical Engel class were determined using an ordered logistic regression model. RESULTS A lifetime history of any mental disorder was a significant predictor of a higher Engel Class (p = 0.017). CONCLUSION This study shows that psychiatric lifetime diagnoses are associated with worse surgical outcome and highlighted the importance of the inclusion of these diagnoses in the evaluation of the potential success of the surgery.
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Affiliation(s)
- Filipa Novais
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Luís Câmara Pestana
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Susana Loureiro
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Mafalda Andrea
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal
| | - Maria Luísa Figueira
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - José Pimentel
- Department of Neurosciences and Mental Health, Neurology Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
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Pope RA, Thompson PJ, Rantell K, Stretton J, Wright MA, Foong J. Frontal lobe dysfunction as a predictor of depression and anxiety following temporal lobe epilepsy surgery. Epilepsy Res 2019; 152:59-66. [DOI: 10.1016/j.eplepsyres.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 11/26/2022]
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Furlan AER, da Silva SC, Marques LHN, de Araujo Filho GM. Are psychogenic nonepileptic seizures risk factors for a worse outcome in patients with refractory mesial temporal epilepsy submitted to surgery? Results of a retrospective cohort study. Epilepsy Behav 2019; 93:12-15. [PMID: 30780075 DOI: 10.1016/j.yebeh.2019.01.036] [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: 10/15/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to verify if the presence of psychogenic nonepileptic seizures (PNES) could be a risk factor precluding corticoamygdalohippocampectomy (CAH) in patients with refractory temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS) (TLE-MTS). METHODS This retrospective cohort study analyzed medical data of patients with refractory TLE-MTS accompanied in a Brazilian epilepsy surgery center. Presurgical psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Engel's I classification two years after surgery was considered as a favorable outcome. RESULTS Of the 81 patients initially included (65 females; 56.5%), 49 (60.5%) had TLE-MTS without PNES, 24 (29.7%) with TLE-MTS and PNES, and eight (9.8%) with PNES only, who were excluded from further statistical comparisons. Nine patients with PNES (37.5%) underwent CAH versus 35 (71.4%) without PNES (p = 0.005). Five patients (55.5%) with PNES versus 26 (74.3%) without PNES presented Engel I (p = 0.54). The relative risk (RR) was of 1.90 for patients without PNES to undergo CAH and of 1.33 to be at Engel I. CONCLUSIONS In this study, PNES were associated with less CAH. There were no differences, however, regarding favorable postsurgical outcomes. These results highlight that the sole presence of PNES should not preclude CAH in patients with TLE-MTS, despite the necessity of careful presurgical psychiatric evaluation.
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Affiliation(s)
- Ana Eliza Romano Furlan
- Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), Brazil
| | - Sebastião Carlos da Silva
- Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), Brazil
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Novais F, Pestana LC, Loureiro S, Andrea M, Figueira ML, Pimentel J. Predicting de novo psychopathology after epilepsy surgery: A 3-year cohort study. Epilepsy Behav 2019; 90:204-208. [PMID: 30573340 DOI: 10.1016/j.yebeh.2018.11.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to determine the potential risk factors for de novo psychiatric syndromes after epilepsy surgery. METHODS Refractory epilepsy surgery candidates were recruited from our Refractory Epilepsy Reference Centre. Psychiatric evaluations were made before surgery and every year, during a 3-year follow-up period. Demographic, psychiatric, and neurological data were recorded. The types of surgeries considered were resective surgery (resection of the epileptogenic zone) and palliative surgery (deep brain stimulation of the anterior nuclei of the thalamus (ANT-DBS)). A survival analysis model was used to determine pre- and postsurgical predictors of de novo psychiatric events after surgery. RESULTS One hundred and six people with refractory epilepsy submitted to epilepsy surgery were included. Sixteen people (15%) developed psychiatric disorders that were never identified before surgery. Multilobar epileptogenic zone (p = 0.001) and DBS of the ANT-DBS (p = 0.003) were found to be significant predictors of these events. CONCLUSION People with more generalized epileptogenic activity and those who undergo ANT-DBS seem to present an increased susceptibility for the development of mental disorders, after neurosurgical interventions, for the treatment of refractory epilepsy. People considered to be at higher risk should be submitted to more frequent routine psychiatric assessments.
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Affiliation(s)
- Filipa Novais
- Psychiatry Department, Santa Maria Hospital, Faculty of Medicine, University of Lisbon, Portugal.
| | - Luís Câmara Pestana
- Psychiatry Department, Santa Maria Hospital, Faculty of Medicine, University of Lisbon, Portugal
| | - Susana Loureiro
- Psychiatry Department, Santa Maria Hospital, Faculty of Medicine, University of Lisbon, Portugal
| | - Mafalda Andrea
- Psychiatry Department, Santa Maria Hospital, Faculty of Medicine, University of Lisbon, Portugal
| | - Maria Luísa Figueira
- Psychiatry Department, Santa Maria Hospital, Faculty of Medicine, University of Lisbon, Portugal
| | - José Pimentel
- Neurology Department, Santa Maria Hospital, Faculty of Medicine, University of Lisbon, Portugal
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Yang W, Chen C, Wu B, Yang Q, Tong D. Comprehensive analysis of presurgical factors predicting psychiatric disorders in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis underwent cortico-amygdalohippocampectomy. J Clin Lab Anal 2018; 33:e22724. [PMID: 30520105 PMCID: PMC6818626 DOI: 10.1002/jcla.22724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/17/2018] [Accepted: 10/29/2018] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to evaluate the predictive value of presurgical factors for psychiatric disorders (PD) in refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE‐MTS) patients underwent cortico‐amygdalohippocampectomy (CAH). Methods A total of 98 refractory TLE‐MTS patients underwent CAH were consecutively enrolled in this cohort study. Several presurgical factors were recorded, such as married status, employment status, highest education, disease duration, family history of epilepsy, and disorganized VEEG background activity. Results There were 17 (17.3%) refractory TLE‐MTS patients occurring PD after CAH, including 8 (8.2%) mood disorders, 7 (7.1%) anxiety disorders, 8 (8.2%) psychoses, and 1 (1.0%) interictal dysphoric disorder. Employed status correlated with low PD occurrence, while disease duration and asymmetric VEEG background activity positively correlated with PD occurrence. Multivariate logistic analysis revealed employed status (P = 0.009) could independently predict lower PD occurrence, while highest education (P = 0.027), disease duration (P = 0.028), seizure frequencies (P = 0.015), and asymmetric VEEG background activity (P = 0.034) could independently predict higher PD occurrence. Receiver operating characteristic curve showed combination of these five factors (area under curve (AUC) = 0.871, 95%CI: 0.783‐0.960) disclosed a great predictive value of PD occurrence. The sensitivity and specificity were 70.6% and 92.6% at the best cutoff point. In addition, the percentage of PD was increased with higher Engel classification (P = 0.003). Conclusion Employed status, highest education, disease duration, seizure frequencies, and asymmetric VEEG background activity correlate with PD occurrence independently in epileptic patients.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China
| | - Chongyi Chen
- Department of Neurosurgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China
| | - Bo Wu
- Department of Neurosurgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China
| | - Qiaoyu Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Dongdong Tong
- Department of Neurosurgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China
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Ramos-Perdigués S, Baillés E, Mané A, Carreño M, Donaire A, Rumià J, Bargalló N, Boget T, Setoain X, Valdés M, Pintor L. Psychiatric Symptoms in Refractory Epilepsy During the First Year After Surgery. Neurotherapeutics 2018; 15:1082-1092. [PMID: 30066084 PMCID: PMC6277301 DOI: 10.1007/s13311-018-0652-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Psychiatric morbidity in drug-resistant epilepsy is frequent. Surgery is the best therapeutic alternative for treating seizures, but the current evidence concerning the effects of surgery on psychiatric disorders (PDs) is inconclusive. We aim to clarify surgery's role in long-term PDs. Using a prospective controlled study, we analyzed the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not due to not being suitable. Surgical candidates were paired (n = 84) with the immediately following nonsurgical candidates (n = 68). Both groups continued their usual medical treatment. We studied psychiatric changes for each group and analyzed de novo and remission cases. The assessments were made during the presurgical evaluation, and at 6 months (6-M) and 12 months (12-M) after surgery. Finally, we determined associated factors for postsurgical PDs. At 12 months, using the Hospital Anxiety and Depression Scale (HADS), anxiety improved in both groups (p = 0.000), while depression improved only in the surgical group (p = 0.016). Moreover, all symptom dimensions on the Symptom Checklist-90-R (SCL-90), as well as severity, distress, and total symptoms, decreased only in the surgical group. These ameliorations reached not only statistical significance but also clinical significance for depression (HADS) (p = 0.014) and the interictal dysphoric disorder (p = 0.013). The main predictors for PDs after surgery were as follows: the presurgical and 6-month psychiatric symptoms, the absence of surgery, seizure outcomes, and some antiepileptic and psychiatric drugs. This study provides evidence that surgery for epilepsy could have a role in improving some symptoms of psychiatric disorders 12-M after the surgery.
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Affiliation(s)
- Sònia Ramos-Perdigués
- Sant Joan de Déu Terres de Lleida Hospital, Avinguda de la Canadiense, 28, 25001, Lleida, Catalonia, Spain.
- Nostra Senyora de Meritxell Hospital, Escaldes-Engordany, AD700, Andorra.
| | - Eva Baillés
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, 08002, Spain
- Autonomous University of Barcelona, Barcelona, 08193, Spain
| | - Anna Mané
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar and Foundation IMIM, Barcelona, 08003, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, 28029, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Nuria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Manuel Valdés
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
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de Barros ACS, Furlan AER, Marques LHN, de Araújo Filho GM. Gender differences in prevalence of psychiatric disorders, levels of alexithymia, and coping strategies in patients with refractory mesial temporal epilepsy and comorbid psychogenic nonepileptic seizures. Epilepsy Behav 2018; 82:1-5. [PMID: 29574297 DOI: 10.1016/j.yebeh.2018.02.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/25/2018] [Accepted: 02/25/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the psychological aspects and psychiatric disorders (PDs) in patients dually diagnosed with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) with psychogenic nonepileptic seizures (PNES) treated in a tertiary center in order to find any gender differences in psychiatric, clinical, and sociodemographic characteristics. METHOD Psychiatric assessment was performed through the Diagnostic and Statistical Manual for Psychiatric Disorders - 5th edition (DSM-5). The Brazilian versions of the Medical Outcomes Study 36 (SF-36), Toronto Alexithymia Scale (TAS-20), Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), and Ways of Coping Checklist (WCC) were applied. RESULTS Of the 47 patients enrolled (25 females; 53.2%), females were significantly more likely to have a history of previous psychiatric treatment (P=0.02), family history of epilepsy (P=0.01), and family history of PD (P=0.03). They also presented earlier onset of PNES (P=0.01) and higher PNES duration (P=0.02) compared with males. Major depressive disorder (MDD) was the most frequent PD (24; 51.0%). Females presented more psychiatric diagnoses (P<0.001), more diagnoses of MDD (P<0.001), and posttraumatic stress disorder (PTSD) (P<0.001). Several differences regarding quality of life, levels of alexithymia, anxiety/depressive symptoms, and coping strategies were observed between groups. CONCLUSIONS There are significant gender differences in psychiatric, clinical, and sociodemographic aspects in a group of patients with TLE-MTS and PNES, as well as in quality of life, levels of alexithymia, anxiety/depressive symptoms, and coping strategies. These gender differences suggest that specific approaches might be adopted depending on the patient's gender and, consequently, their distinct psychological/psychiatric profile.
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de Barros ACS, Furlan AER, Marques LHN, de Araújo Filho GM. Effects of a psychotherapeutic group intervention in patients with refractory mesial temporal lobe epilepsy and comorbid psychogenic nonepileptic seizures: A nonrandomized controlled study. Seizure 2018; 58:22-28. [DOI: 10.1016/j.seizure.2018.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 01/01/2023] Open
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Goji H, Fukuchi T, Kanemoto K. Pre- and post-surgical psychiatric assessments and intervention by major epilepsy centers in Japan - Nationwide survey. Epilepsy Behav 2017; 70:61-65. [PMID: 28411517 DOI: 10.1016/j.yebeh.2017.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 02/12/2017] [Accepted: 02/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although psychiatric issues following epilepsy surgery are now widely recognized as a major problem, actual awareness of these issues by epilepsy centers remains to be elucidated. This is the first known report regarding the use of psychiatric assessments and interventions by epilepsy centers throughout Japan. PARTICIPANTS AND METHODS At the beginning of 2016, we sent a questionnaire regarding psychiatric assessments performed before and after epilepsy surgery, psychiatric intervention after surgery, and future plans for dealing with psychiatric issues in relation to epilepsy surgery, which consisted of a total of 24 items, to all members of the Japan Epilepsy Center Association (JEPICA). Nearly all major epilepsy centers in Japan are included in JEPICA, which had 31 members in 2016. Twenty-four (77%) of the 31 centers responded to the questionnaire. RESULTS Seventeen (70.8%) centers answered that a psychiatrist was incorporated as part of their epilepsy surgery unit. In addition, 17 (70.8%) noted that psychiatric assessments were obtained prior to surgery, which were performed by psychiatrists in 8 (33.3%) centers and psychologists in 11 (45.8%). In 23 (95.8%) of the centers, the risk of occurrence of psychiatric illness following surgery was routinely explained prior to surgery, at least to surgical candidates with high susceptibility. In total, cases of psychiatric illness following surgery had been experienced in 16 (66.7%) centers, with depression as the most commonly encountered (41.7%), followed by anxiety (33.3%), psychosis (25.0%), and psychogenic non-epileptic seizures (8.3%). DISCUSSION Strong points of epilepsy centers in Japan include serious concern regarding post-surgical psychiatric illness by nearly all members of JEPICA and explanation of the risk of psychiatric adverse events provided beforehand to their patients. On the other hand, the small size of some epilepsy centers, along with lack of a standardized method for evaluation of psychiatric symptoms as well as dependence on the individual willingness of psychiatrists assigned as members of the epilepsy units, seem to have led to significant diagnostic and therapeutic gaps among epilepsy centers regarding psychiatric issues related to epilepsy surgery.
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Affiliation(s)
- Hiroko Goji
- Aichi Medical University, Neuropsychiatric Department, Yazako-Karimata 1-1, Nagakute, Japan
| | | | - Kousuke Kanemoto
- Aichi Medical University, Neuropsychiatric Department, Yazako-Karimata 1-1, Nagakute, Japan.
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Koch-Stoecker SC, Bien CG, Schulz R, May TW. Psychiatric lifetime diagnoses are associated with a reduced chance of seizure freedom after temporal lobe surgery. Epilepsia 2017; 58:983-993. [PMID: 28378900 DOI: 10.1111/epi.13736] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine whether psychiatric comorbidity is a predictor of long-term seizure outcome following temporal lobe epilepsy surgery. METHODS A sample of 434 adult patients who received temporal lobe resection to treat epilepsy between 1991 and 2009 and were psychiatrically assessed before surgery were followed for 2 years to assess seizure outcome. Stepwise multivariate logistic regression analyses were used to assess the impact of psychiatric variables on complete seizure freedom (Engel class IA), and freedom from disabling seizures (Engel class I). Lifetime histories of three psychiatric syndromes (PS: psychosis; depression; other) and five personality disorders (PD: DSM-IV Clusters A, B, and C; organic personality disorder; other) were considered as predictors, complemented by age at onset, duration of epilepsy, type of lesion (mesiotemporal sclerosis vs. other), and year of surgery. RESULTS Seizure-freedom rates were significantly higher (p < 0.001) in patients with no history of PS or PD (N = 138; Engel class IA: 61.6%; Engel class I: 87.7%) than in those with any PS or PD (N = 296; Engel class IA: 39.5%; Engel class I: 58.8%). Particularly low seizure-freedom rates were found in patients with a diagnosis of psychosis (N = 32, Engel class IA: 21.9%; Engel class I: 40.6%), organic PD (N = 48, Engel class IA: 25.0%; Engel class I: 35.4%) or a double diagnosis of PS plus PD (N = 97; Engel class IA: 27.8%; Engel class I: 45.5%). No other variables emerged as significant risk factors in multivariate logistic regression analyses. SIGNIFICANCE Patients with and without psychiatric comorbidities can benefit from temporal lobe epilepsy surgery; however, psychiatric comorbidities are negatively associated with postoperative seizure-freedom rates. Surgical outcome is related to the type and extent of preoperative psychiatric morbidity, which underscores the prognostic value of presurgical psychiatric evaluation. The data support the argument that there are common pathogenetic mechanisms underlying both epilepsy and psychiatric conditions.
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Affiliation(s)
- Steffi C Koch-Stoecker
- Department of Psychiatry and Psychotherapy, Evangelical Clinic Bethel, Bielefeld, Germany
| | | | - Reinhard Schulz
- Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany
| | - Theodor W May
- Society for Epilepsy Research, Epilepsy Center Bethel, Bielefeld, Germany
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Clinical and sociodemographic variables associated with interictal dysphoric disorder and interictal personality in patients with drug-resistant temporal lobe epilepsy: A controlled study. Epilepsy Behav 2017; 69:100-103. [PMID: 28236724 DOI: 10.1016/j.yebeh.2017.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/23/2022]
Abstract
Psychiatric disorders (PD) have an elevated prevalence and an important negative impact on patients with epilepsy (PWE) since they are associated with lower quality of life and clinical refractoriness. However, it is also necessary to identify behavioral conditions possibly associated with epilepsy that are not part of the standard psychiatric classifications, such as Interictal Dysphoric Disorder (IDD) and Interictal Personality (IP). The frequency of IDD and IP in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) was assessed. The Brazilian versions of the Neurobehavioral Inventory (NBI) and Interictal Dysphoric Disorder Inventory (IDDI) were applied to patients and to a control group. Psychiatric standard assessment was conducted through the Diagnostic and Statistical Manual for Psychiatric Disorders - 5th edition (DSM-5). The value of p considered significant was <0.05. Ninety-five patients (51 women; 53.6%) and 50 controls (29 women; 58.0%) were assessed. Axis I PD were observed in 41 patients (43.1%). Interictal Dysphoric Disorder was observed in 18 patients (18.4%) and IP in 36 (37.9%). Interictal Dysphoric Disorder was associated with left-sided MTS (OR=3.22; p=0.008), previous psychiatric treatment (OR=4.29; p=0.007), and more than one AED used (OR=2.73; p=0.02) while presence of bilateral MTS (OR=3.27; p=0.008), longer disease duration (OR=3.39; p=0.006), and presence of Major Depressive Disorder (OR=4.73; p=0.004) were associated with IP. In the present study, there was a high prevalence of IDD and IP in patients with drug-resistant TLE-MTS; studies should be conducted to identify the presence of behavioral conditions that are not present in the conventional psychiatric classifications.
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Epilepsy-related psychoses and psychotic symptoms are significantly reduced by resective epilepsy surgery and are not associated with surgery outcome or epilepsy characteristics: A cohort study. Psychiatry Res 2016; 245:333-339. [PMID: 27573056 DOI: 10.1016/j.psychres.2016.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 07/04/2016] [Accepted: 08/06/2016] [Indexed: 11/23/2022]
Abstract
We examine epilepsy-related psychoses and psychotic symptoms (ERPs) and the effects of epilepsy surgery on inter-ictal, aura, ictal and peri-ictal (pre- and post-ictal) psychoses. We included 189 patients with refractory epilepsy both before and 24 months after surgery. Engel's classification was the primary outcome measurement. Epilepsy surgery reduced the prevalence of ERPs from 17.5% to 4.2%, psychotic aura from 7.9% to 0.5%, ictal psychoses from 3.7% to 1.1% and peri-ictal psychoses from 4.2% to 0.5%. The prevalence of inter-ictal psychoses decreased from 5.3% to 0.5%, but 4 new cases of inter-ictal psychoses were found following surgery. Interictal dysphoric disorder significantly predicted surgery outcome. In patients with and without ERPs, epilepsy surgery induced seizure reduction in more than 90% of the cases, showing that both groups benefit equally from surgery. No associations between ERPs and epileptic characteristics were found, including laterality, type of lesion, type of epilepsy, number of seizures, duration of illness or age at onset. Epilepsy surgery significantly improves ERPs particularly psychotic aura and peri-ictal psychoses. Although inter-ictal psychoses are successfully treated, new inter-ictal psychoses appear in a few cases either as alternative psychoses or a possible switch from pre-surgery episodic into inter-ictal psychoses.
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28
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Diagnosing and treating depression in epilepsy. Seizure 2016; 44:184-193. [PMID: 27836391 DOI: 10.1016/j.seizure.2016.10.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 01/24/2023] Open
Abstract
At least one third of patients with active epilepsy suffer from significant impairment of their emotional well-being. A targeted examination for possible depression (irrespective of any social, financial or personal burdens) can identify patients who may benefit from medical attention and therapeutic support. Reliable screening instruments such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) are suitable for the timely identification of patients needing help. Neurologists should be capable of managing mild to moderate comorbid depression but referral to mental health specialists is mandatory in severe and difficult-to-treat depression, or if the patient is acutely suicidal. In terms of the therapeutic approach, it is essential first to optimize seizure control and minimize unwanted antiepileptic drug-related side effects. Psychotherapy for depression in epilepsy (including online self-treatment programs) is underutilized although it has proven effective in ten well-controlled trials. In contrast, the effectiveness of antidepressant drugs for depression in epilepsy is unknown. However, if modern antidepressants are used (e.g. SSRI, SNRI, NaSSA), concerns about an aggravation of seizures and or problematic interactions with antiepileptic drugs seem unwarranted. Epilepsy-related stress ("burden of epilepsy") explains depression in many patients but acute and temporary seizure-related states of depression or suicidality have also been reported. Limbic encephalitits may cause isolated mood alteration without any recognizable psychoetiological background indicating a possible role of neuroinflammation. This review will argue that, overall, a bio-psycho-social model best captures the currently available evidence relating to the etiology and treatment of depression as a comorbidity of epilepsy.
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Shukla G, Agarwal P, Sagar R, Sood M, Gupta A, Suri A, Garg A. Does antiepileptic drug withdrawal predispose patients undergoing temporal lobe epilepsy surgery to late onset of psychiatric morbidity? A report of three cases. Ann Indian Acad Neurol 2016; 19:377-80. [PMID: 27570392 PMCID: PMC4980963 DOI: 10.4103/0972-2327.186828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Surgery is an established and increasingly utilized treatment option in medically refractory temporal lobe epilepsy. Many psychiatric problems are known to complicate in the postoperative period. Most studies have a follow-up period of less than 24 months. We report the cases of three patients who developed severe psychiatric problems in the late postoperative period after successful temporal lobectomy for refractory epilepsy — Psychosis, major depression with psychosis, and severe anxiety disorder, respectively. None of the patients had past or family history of psychiatric disease. All three patients had undergone anterior temporal lobectomy on the right side for intractable epilepsy. They remained absolutely seizure-free after surgery. We conclude that psychiatric morbidity may arise de novo long after temporal lobectomy. This association between temporal lobectomy for epilepsy and late onset psychiatric morbidity should be carefully studied. Mechanisms underlying this late complication require deeper understanding of the effects of epilepsy surgery.
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Affiliation(s)
- Garima Shukla
- Deptarment of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Agarwal
- Deptarment of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Deptarment of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Deptarment of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Gupta
- Deptarment of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Deptarment of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Deptarment of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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30
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Ramos-Perdigués S, Baillés E, Mané A, Carreño M, Donaire A, Rumia J, Bargalló N, Boget T, Setoain X, Valdes M, Pintor L. A prospective study contrasting the psychiatric outcome in drug-resistant epilepsy between patients who underwent surgery and a control group. Epilepsia 2016; 57:1680-1690. [PMID: 27562413 DOI: 10.1111/epi.13497] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Psychiatric morbidity in drug-resistant epilepsy is frequent and has a negative influence on quality of life. Surgery is proven to be the best therapeutic alternative for treating seizures. However, it is inconclusive with the current evidence whether surgery, per se, is a risk factor or promotes amelioration of psychiatric disorders. Until now, most studies have been cross-sectional with small or heterogeneous groups. In addition, the few prospective studies did not have an identical control group. The present study aims to clarify the role of surgery in psychopathologic alterations. METHODS We analyzed, through a prospective case-control study, the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery and those who continued with pharmacologic treatment due to not being suitable for surgery. The assessments were performed during presurgical evaluation and 6 months after surgery. We studied psychiatric changes for each group, compared differences between groups, and also analyzed de novo and remission cases. Finally, we determined associated factors for postsurgical psychiatric disturbances. RESULTS The surgical group experienced a significant decrease in psychopathologic alterations in comparison with the control group. In addition, distress perception of surgical patients also improved, whereas it did not decrease in the control group. Patients who underwent surgery presented a decrease in depressive and anxiety symptoms, whereas the nonsurgical group increased its anxiety levels. De novo disturbances that appeared after surgery were less frequent than in nonsurgical patients. We observed significant favorable outcomes considering de novo versus remission cases for anxiety, depression, and total symptoms only in the surgical group. The two main predictors for psychiatric disorders after surgery were presurgical psychiatric functioning and surgery. SIGNIFICANCE Provides evidence that surgery improves psychiatric functioning in drug-resistant epilepsy through a prospective controlled study.
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Affiliation(s)
| | - Eva Baillés
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Mané
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar and Foundation IMIM, Barcelona, Spain.,Center for Biomedical Research in Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jordi Rumia
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Nuria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Manuel Valdes
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
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31
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Alonso NB, Mazetto L, de Araújo Filho GM, Vidal-Dourado M, Yacubian EMT, Centeno RS. Psychosocial factors associated with in postsurgical prognosis of temporal lobe epilepsy related to hippocampal sclerosis. Epilepsy Behav 2015; 53:66-72. [PMID: 26520878 DOI: 10.1016/j.yebeh.2015.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Abstract
We examined the long-term psychosocial trajectory in a consecutive and homogeneous series of 120 patients followed up for five years after corticoamygdalohippocampectomy (CAH). Evaluation of psychosocial variables at baseline and at five-year follow-up were compared. After five years of CAH, a significant improvement in educational level (p=0.004) and employment status (p<0.001) was observed, although retirement (p<0.001) and divorce (p=0.021) rates increased. In a long-term follow-up, a tendency to have similar QOL profile was observed between Engel classes IA and IB (p>0.05). A more favorable surgical outcome (Engel IA) was related to better psychiatric status (p=0.012). Poor psychosocial adjustment before surgery was the most important predictor of QOL outcome (p<0.05). Patients' trajectory after surgical treatment showed positive effects mainly in those with better seizure outcome. Our results emphasized the influence regarding baseline psychosocial functioning on postoperative psychosocial adjustment. Furthermore, many psychosocial gains and difficulties after surgery may be similar in developing and developed countries.
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Affiliation(s)
| | - Lenon Mazetto
- Department of Neurology, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil
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32
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Garcia Gracia C, Yardi R, Kattan MW, Nair D, Gupta A, Najm I, Bingaman W, Gonzalez-Martinez J, Jehi L. Seizure freedom score: A new simple method to predict success of epilepsy surgery. Epilepsia 2014; 56:359-65. [DOI: 10.1111/epi.12892] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Camilo Garcia Gracia
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Ruta Yardi
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Michael W. Kattan
- Quantitative Health Sciences; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Dileep Nair
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Ajay Gupta
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Imad Najm
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - William Bingaman
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Jorge Gonzalez-Martinez
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
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33
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Pollak TA, Nicholson TR, Mellers JDC, Vincent A, David AS. Epilepsy-related psychosis: a role for autoimmunity? Epilepsy Behav 2014; 36:33-8. [PMID: 24840753 DOI: 10.1016/j.yebeh.2014.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 12/20/2022]
Abstract
Postictal psychosis (PIP) is a serious psychiatric complication of epilepsy that occurs in approximately 6% of patients following multiple complex partial or generalized seizures. The psychosis is classically described as having a pleomorphic phenomenology, including paranoid, grandiose, and religious delusions as well as multimodal hallucinations with prominent affective changes and agitation. Little is understood about the pathophysiology of the condition. There has been a recent increase in interest in the relevance of autoimmunity to the pathogenesis of both epilepsy and psychosis. Studies have demonstrated the presence of antibodies directed against synaptic autoantigens (such as the N-methyl-d-aspartate receptor or the voltage-gated potassium channel complex) in approximately 10% of cases of sporadic epilepsy. These same autoantibodies are known to cause encephalopathy syndromes which feature psychiatric symptoms, usually psychosis, as a prominent part of the phenotype as well as other neurological features such as seizures, movement disorders, and autonomic dysfunction. It is beginning to be asked if these antibodies can be associated with a purely psychiatric phenotype. Here, we hypothesize that PIP may be an autoimmune phenomenon mediated by autoantibodies against synaptic antigens. More specifically, we outline a potential mechanism whereby long or repeated seizures cause short-lived blood-brain barrier (BBB) dysfunction during which the brain becomes exposed to pathogenic autoantibodies. In essence, we propose that PIP is a time-limited, seizure-dependent, autoantibody-mediated encephalopathy syndrome. We highlight a number of features of PIP that may be explained by this mechanism, such as the lucid interval between seizures and onset of psychosis and the progression in some cases to a chronic, interictal psychosis.
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Affiliation(s)
- T A Pollak
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK; Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - T R Nicholson
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK; Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | | | - A Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - A S David
- Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
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34
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Changes in psychiatric comorbidity during early postsurgical period in patients operated for medically refractory epilepsy--a MINI-based follow-up study. Epilepsy Behav 2014; 32:29-33. [PMID: 24463306 DOI: 10.1016/j.yebeh.2013.11.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/20/2013] [Accepted: 11/27/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to assess axis-I DSM-IV psychiatric disorders in patients at baseline and 3 months after surgery for medically refractory temporal lobe epilepsy. METHOD The Mini International Neuropsychiatric Interview (MINI) and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were evaluated before and 3 months after surgery in 50 consecutive patients (21 females, 29 males) with medically refractory temporal lobe epilepsy (persistent seizures>2/month, despite treatment with ≥2 appropriate drugs in adequate doses for ≥2 years) who underwent surgery [anterior temporal lobectomy with amygdalo-hippocampectomy (for mesial temporal sclerosis in 40), electrocorticography-guided lesionectomy (for other lesions in 10)]. RESULTS Twenty-six patients (52%) had an axis-I psychiatric disorder [26% depressive disorder, 28% anxiety disorder] at baseline, while 30 (60%) patients had an axis-I psychiatric disorder [28% depressive disorder, 28% anxiety disorder] at 3 months after surgery. Twenty percent developed a new psychiatric disorder, while 12% showed improvement postsurgery. Mean QOLIE-10 scores improved from 23.78 to 17.80 [24 (48%) patients showed ≥5-point improvement]. Thirty-four (68%) patients had no seizure, 6 (12%) had non-disabling seizures, while 2 (4%) had disabling seizures after surgery. High frequency of seizures prior to surgery (p<0.038) and seizure occurrence after surgery (p<0.055) predicted the presence of psychiatric disorders after surgery. No clinical characteristic could predict development of new psychiatric disorder after surgery. CONCLUSION Psychiatric dysfunction in the early postsurgery period is seen in nearly half of patients undergoing surgery for temporal lobe epilepsy, is mild in nature, and does not adversely affect quality of life but may cause significant clinical problems when it arises de novo postsurgery.
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Karouni M, Henning O, Larsson PG, Johannessen SI, Johannessen Landmark C. Pharmacological treatment of psychiatric comorbidity in patients with refractory epilepsy. Epilepsy Behav 2013; 29:77-81. [PMID: 23939032 DOI: 10.1016/j.yebeh.2013.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/06/2013] [Accepted: 06/29/2013] [Indexed: 11/27/2022]
Abstract
The purpose of the present study was to describe the use of psychopharmacological drugs for the treatment of a stated or presumed psychiatric comorbid condition in patients with refractory epilepsy and discuss the clinical implications of such treatment. The study was a retrospective descriptive study in patients admitted to the National Center for Epilepsy in Norway based on medication described in medical records. The mean age was 40 years (range: 9-90), and the gender ratio was 56/44% female/male. Psychotropic drugs (antidepressants and antipsychotics) were used to a lower extent than in the general population in Norway. Drugs for ADHD were predominantly used in children. The prevalence of patients treated with psychiatric comedication was 13% (143 of 1139 patients). The patients used two to eight concomitant CNS-active drugs, which calls for the close monitoring of potential pharmacodynamic and pharmacokinetic interactions and should challenge clinicians to achieve a less complex pharmacotherapy. Psychiatric comorbidity is an important concern in patients with refractory epilepsy and may be undertreated.
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36
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da Conceição PO, Nascimento PP, Mazetto L, Alonso NB, Yacubian EMT, de Araujo Filho GM. Are psychiatric disorders exclusion criteria for video-EEG monitoring and epilepsy surgery in patients with mesial temporal sclerosis? Epilepsy Behav 2013; 27:310-4. [PMID: 23523814 DOI: 10.1016/j.yebeh.2013.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/07/2013] [Accepted: 02/16/2013] [Indexed: 11/30/2022]
Abstract
Epilepsy surgery (ES) is a treatment option for patients with refractory temporal lobe epilepsy (TLE). However, psychiatric disorders (PDs) have been a contraindication for presurgical evaluation in many epilepsy centers. The aim of this study was to evaluate the safety of video-EEG (VEEG) and surgical outcome in patients with refractory TLE and mesial temporal sclerosis (TLE-MTS) associated with PDs. We retrospectively analyzed the clinical, sociodemographic, and VEEG data and surgery outcome of patients with refractory TLE-MTS who underwent ES over the period of 2002 to 2011 and compared data between those with and without PDs. Psychiatric evaluation was performed through DSM-IV and ILAE criteria. Safety during presurgical evaluation was analyzed by the rate of adverse events (AEs). Patients' quality of life (QOL) was measured through ESI-55 and the surgical outcome through Engel's classification. Data from 145 patients were included. The mean VEEG length (93h) was not affected by PDs. Among patients with PDs, 4.91% (3/61) had AEs, and 13.11% (8/61) had psychogenic nonepileptic seizures (PNESs). Among patients without PDs, 4.76% (4/84) had AEs, and 5.95% (5/84) had PNESs. In the first two follow-up years, of the 94 patients who underwent ES, 65.85% (27/41) with PDs and 67.92% (36/53) without PDs became free of disabling seizures (Engel I). No significant differences were observed in the patients' QOL between both groups after surgery. The rate of AEs and seizure outcome did not differ significantly between both groups, reinforcing the idea that PDs should not be absolute exclusion criteria for VEEG monitoring and epilepsy surgery among patients with TLE-MTS.
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