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Verly G, Oliveira LDB, Delfino T, Batista S, Lopes T, Carvalho V, McBenedict B, Oliveira M, Bertani R, Martins da Cunha PH, Paiva W, Lima Pessoa B. Assessing short-term and long-term security and efficacy of anterior nucleus of the thalamus deep brain stimulation for treating drug-resistant epilepsy: A systematic review and single-arm meta-analysis. Epilepsia 2024; 65:1531-1547. [PMID: 38506635 DOI: 10.1111/epi.17955] [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: 11/01/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a widespread invasive procedure for treating drug-resistant epilepsy. Nonetheless, there is a persistent debate regarding the short-term and long-term efficacy and safety of ANT-DBS. Thus we conducted a systematic review and meta-analysis. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we searched PubMed, Cochrane, Embase, and Web of Science for studies treating refractory epilepsy with ANT-DBS. Short-term analysis was considered for studies with a mean follow-up of 3 years or less. The following outcomes were assessed for data extraction: procedure responders and nonresponders, increased seizure frequency, complications, and procedure-related mortality. Of 650 studies, 25 fit our inclusion criteria, involving 427 patients. Previous surgical treatments have been reported in 214 patients (50.1%) and a median average baseline seizure frequency of 64.9 monthly seizures. In the short-term analysis, we observed a proportion of 67% (95% confidence interval [CI] 54%-79%) of responders and 33% (95% CI 21%-46%) of nonresponders. In addition, 4% (95% CI 0%-9%) of the patients presented increased seizure frequency. In the long-term analysis, we observed 72% (95% CI 66%-78%) responders and 27% (95% CI 21%-34%) nonresponders. Moreover, there was a 2% (95% CI 0%-5%) increase in seizure frequency. No procedure-related mortality was reported at any follow-up. ANT-DBS effectively treats refractory epilepsy, with lasting short-term and long-term benefits. It remains safe and efficient despite complications, showing no procedure-linked fatalities, high patient responsiveness, and minimal increased seizures. Consistent results over time and low morbidity/mortality rates emphasize its worth. Further research is necessary to diminish the discrepancy among results.
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Affiliation(s)
- Gabriel Verly
- Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Thiffany Delfino
- Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sávio Batista
- Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thiago Lopes
- Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vitória Carvalho
- Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Billy McBenedict
- Faculty of Medicine, Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, Brazil
| | - Matheus Oliveira
- Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raphael Bertani
- Division of Neurological Surgery, Hospital das Clínicas, Universidade de São Paulo (USP), São Paulo, Brazil
| | | | - Wellingson Paiva
- Division of Neurological Surgery, Hospital das Clínicas, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Bruno Lima Pessoa
- Division of Neurological Surgery, Hospital Antônio Pedro, Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, Brazil
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Aljafen BN, Alneseyan R, Muayqil T, Alkhateeb MO, Aldosari MM, Alsermani A, Alnakhli L, Althomali R, Alnami R, Alqahtani R, Ibrahim L, Babtain F. Evaluating the prevalence and risk factors for depression in patients with temporal lobe epilepsy with hippocampal sclerosis: A cross-sectional multicenter study. Epilepsy Behav 2024; 154:109782. [PMID: 38636108 DOI: 10.1016/j.yebeh.2024.109782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Epilepsy frequently accompanies Major Depressive Disorder (MDD). Notably, people with temporal lobe epilepsy and hippocampal sclerosis may face an increased susceptibility to MDD, as evidence indicates the involvement of the limbic system in the development of emotional symptoms. OBJECTIVES To determine the prevalence and predictors of depression in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and compare them to those of other epilepsy types. METHODS A sample of 293 epilepsy patients, including 159 non-TLE-HS and 134 TLE-HS, were recruited from three hospitals. Of these, 215 completed a two-section electronic survey. The first section collected demographic and epilepsy data, while the second used the Arabic version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). RESULTS Of 215 patients, 104 (48%) had TLE-HS-38 with right TLE-HS (37%), 56 with left TLE-HS (54%), and 10 with bilateral TLE-HS (10%). The prevalence and severity of depression was assessed with an NDDI-E score of 15 or higher identified 35 patients (16%) with MDD. Valproic acid and lamotrigine were associated with higher NDDI-E scores. No such associations were found for levetiracetam or carbamazepine. Polytherapy in TLE-HS showed a significant correlation with daily poor concentration. CONCLUSION We explored the differences in depression prevalence between TLE-HS and other epilepsy types and concluded they are minimal but slightly higher in TLE-HS. Predictors of depression such as seizure frequency and disease duration influenced MDD prevalence in TLE-HS. Lamotrigine and valproate were linked to higher NDDI-E scores.
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Affiliation(s)
- Bandar N Aljafen
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Ruwa Alneseyan
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Taim Muayqil
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mashael O Alkhateeb
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Alfasial University, Riyadh, Saudi Arabia
| | - Mubarak M Aldosari
- Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aya Alsermani
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Lujain Alnakhli
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Renad Althomali
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Razan Alnami
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Ruba Alqahtani
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Lama Ibrahim
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Fawzi Babtain
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Wang Y, Shen C, Zhang J, Yang Q, Li J, Tan J, Yu H, Mei Z. A protocol for a pooled analysis of cohort studies: The association between depression and anxiety in epileptic disorders. PLoS One 2023; 18:e0295328. [PMID: 38060471 PMCID: PMC10703227 DOI: 10.1371/journal.pone.0295328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND/INTRODUCTION Depressive and anxiety disorders constitute major mental health challenges affecting adults of all ages globally. It has been reported that individuals with depressive or anxiety disorders face an elevated risk of developing neurological conditions, including seizures and epilepsy. Additionally, people with these disorders tend to exhibit distinct clinical outcomes compared to the general population. However, the associations between depressive or anxiety disorders and epilepsy remain contentious. Thus, this study aims to elucidate the associations between these neuropsychiatric disorders, including depressive and anxiety disorders, and epilepsy or seizures. METHODS We will systematically search three electronic databases-PubMed, EMBASE, and the Cochrane Library-from inception through March 2023 to identify relevant cohort studies investigating the associations between depressive or anxiety disorders and epilepsy or seizures. Two independent reviewers will extract data from eligible studies using pre-designed standardized data extraction forms, and cross-check results. A third author will resolve any discrepancies. Quality assessment will be performed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Pooled risk estimates (Relative risks or hazard ratios with their 95% CI) will be calculated using the DerSimonian-Laird random-effects model. If between-study heterogeneity is identified, we will conduct subgroup analyses or meta-regressions to explore the possible sources of heterogeneity (participants, exposure, outcome, and study design) stratified by various study characteristics. Potential publication bias will be detected through the inspection of funnel plot asymmetry, complemented by the Egger linear regression approach (Egger's test) and the Begg rank correlation test (Begg's test). DISCUSSION This pooled analysis will evaluate the association between depressive or anxiety disorders and epilepsy or seizures, providing high-level evidence to inform early identification and prevention strategies for epilepsy or seizures. ETHICS AND DISSEMINATION Given that the data utilized for analysis in this pooled analysis does not involve human subjects or medical records, no ethical approval is required for this study. We intend to present the results of this study at national or international conferences or submit the findings to a peer-reviewed journal. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/WM2X8.
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Affiliation(s)
- Yan Wang
- Department of Neurology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Changbo Shen
- Department of Neurology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Junyan Zhang
- Department of Neurology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Qingcheng Yang
- Department of Neurology, The People’s Hospital of Anyang City, Anyang, China
| | - Jianshe Li
- Department of Neurology, Xinxiang Central Hospital, Henan Province, China
| | - Jun Tan
- Department of Neurology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hang Yu
- Emergency Department, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
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Guo W, Li YX, Zhang Y, Lv XR, Wang SX, Zhang SY, Wang ES, Chen XJ, Li Y. Risk analysis of depression among adult patients with epilepsy of different sex: a retrospective single-center study from China. Front Psychiatry 2023; 14:1283983. [PMID: 38111615 PMCID: PMC10725914 DOI: 10.3389/fpsyt.2023.1283983] [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: 08/27/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Objective To determine sex differences in the prevalence of depression and assess the risk factors for depression among adult patients with epilepsy from the Dali area of China. Methods We retrospectively analyzed the clinical data of adult patients with epilepsy who visited the First Affiliated Hospital of Dali University from January 2017 to January 2022. Patient Health Questionnaire-9 was used to assess depressive symptoms in patients with epilepsy. The risk factors of depression were analyzed by binary logistic regression among different sex in patients with epilepsy. Results There were significant sex differences in depression in patients with epilepsy (p < 0.001), and females were 4.27 times more likely to suffer from depression than males (95% confidence interval: 3.70-4.92). The risk factors for depression among female patients with epilepsy included occupation (p < 0.001), years with epilepsy (p < 0.001), seizure frequency (p < 0.001), seizure type (p < 0.001), etiology (p < 0.001), number of antiseizure medications used (p < 0.001), antiseizure medications (p < 0.001), and electroencephalogram findings (p < 0.001). The risk factors for depression among male patients with epilepsy included age (p < 0.001), ethnicity (p < 0.001), occupation (p < 0.001), years with epilepsy (p < 0.001), seizure frequency (p < 0.001), seizure type (p < 0.001), etiology (p < 0.001), number of antiseizure medications used (p < 0.001), antiseizure medications (p < 0.001), and electroencephalogram findings (p < 0.001). Conclusion Adult female patients with epilepsy had a higher risk of depression than adult male patients with epilepsy. There were sex differences in the risk factors associated with depression among patients with epilepsy.
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Affiliation(s)
- Wang Guo
- Clinical Medical School, Dali University, Dali, China
| | - Yu-xuan Li
- Clinical Medical School, Dali University, Dali, China
| | - Yi Zhang
- Clinical Medical School, Dali University, Dali, China
| | - Xue-rui Lv
- Clinical Medical School, Dali University, Dali, China
| | | | - Shuang-yuan Zhang
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
| | - En-si Wang
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
| | - Xin-jie Chen
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
| | - Yun Li
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
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Lim KS, Wong KY, Chee YC, Fong SL, Yu X, Ng CG, Tang V, Lai ST, Audrey C, Shauna A, Tan CT. Feasibility of psychological screening in a tertiary epilepsy clinic. Epilepsy Behav 2023; 148:109455. [PMID: 37774547 DOI: 10.1016/j.yebeh.2023.109455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/16/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE People with epilepsy (PWE) have a high prevalence of developing depression and anxiety. The objective is to determine the feasibility of brief screening tools to screen for depression and anxiety in epilepsy, and the predictive factors. METHOD This is a cross-sectional study in the neurology clinic in a tertiary teaching hospital in Kuala Lumpur. The screening tools used were the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the General Anxiety Disorder Form (GAD-7). RESULTS Five hundred and eighty-five patients were recruited in this study, and 50.8% of them were male, predominantly Chinese (46.7%), with a mean age of seizure onset of 21.8 ± 16.1 years. The majority had focal seizures (75.0%), and 41.9% had seizure remission. There were 15.5% who scored ≥15 in the NDDI-E, and 17.0% had moderate or severe anxiety (scored ≥10 in the GAD-7). In a regression model to predict the NDDI-E score, the age of seizure onset recorded a higher beta value (β = -0.265, p =< 0.001), followed by the duration of epilepsy (β = -0.213, p =< 0.001), use of levetiracetam (LEV) (β = 0.147, p = 0.002), clonazepam (CLZ) (β = 0.127, p = 0.011), and lamotrigine (LTG) (β = 0.125, p = 0.011), number of current antiseizure medications (β = -0.124, p = 0.049), seizure remission for ≥1 year (β = -0.108, p = 0.011), and female (β = 0.082, p = 0.049). For the GAD-7 score, the predictors included current age (β = -0.152, p = 0.001), the use of LEV (β = 0.122, p = 0.011), Indian ethnicity (β = 0.114, p = 0.006), and the use of carbamazepine (β = -0.090, p = 0.043). CONCLUSION Implementation of simple psychological screening using self-administered questionnaires was feasible in a busy tertiary epilepsy clinic.
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Affiliation(s)
- Kheng-Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Kian-Yong Wong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong-Chuan Chee
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Xuen Yu
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong-Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Venus Tang
- Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Siew-Tim Lai
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Christine Audrey
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aminath Shauna
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong-Tin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Qin SK, Yang ZX, Guan ZW, Zhang JH, Ping X, Lu Y, Pei L. Exploring the association between epilepsy and depression: A systematic review and meta-analysis. PLoS One 2022; 17:e0278907. [PMID: 36520790 PMCID: PMC9754200 DOI: 10.1371/journal.pone.0278907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study offers meta-analytic data on the potential association between epilepsy and depression especially for the prevalence of depression in epilepsy or vice versa. METHODS The relevant studies were searched and identified from nine electronic databases. Studies that mentioned the prevalence and/or incidence of epilepsy and depression were included. Hand searches were also included. The search language was English and the search time was through May 2022. Where feasible, random-effects models were used to generate pooled estimates. RESULTS After screening electronic databases and other resources, 48 studies from 6,234 citations were included in this meta-analysis. The period prevalence of epilepsy ranged from 1% to 6% in patients with depression. In population-based settings, the pooled period prevalence of depression in patients with epilepsy was 27% (95% CI, 23-31) and 34% in clinical settings (95% CI, 30-39). Twenty studies reported that seizure frequency, low income, unemployment of the patients, perception of stigma, anxiety, being female, unmarried status, disease course, worse quality of life, higher disability scores, and focal-impaired awareness seizures were risk factors for depression. CONCLUSION Our study found that epilepsy was associated with an increased risk of depression. Depression was associated with the severity of epilepsy.
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Affiliation(s)
- Shao-kun Qin
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
| | - Zi-xian Yang
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- School of Chinese Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Zhen-wei Guan
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
| | - Jin-hu Zhang
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
| | - Xin Ping
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
| | - Ye Lu
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
- * E-mail: (YL); (LP)
| | - Lin Pei
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
- * E-mail: (YL); (LP)
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Epilepsie birgt Depressionsrisiko. FORTSCHRITTE DER NEUROLOGIE · PSYCHIATRIE 2022. [DOI: 10.1055/a-1899-6586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Nicht selten wird eine Epilepsieerkrankung noch zusätzlich durch eine
affektive Störung verkompliziert. In bisheriger Forschung zeigen sich
Prävalenzen von 11% bis hin zu 60% bei
Epilepsiepatienten. Speziell depressive Störungen scheinen mit Epilepsie
zusammenzuhängen. Jedoch weisen neuere Studien auch
widersprüchliche Ergebnisse auf. Eine Metanalyse aus China liefert nun
neue Belege für einen Zusammenhang.
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