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Talıbov T, İnci M, Ismayılov R, Elmas S, Büyüktopçu E, Kepenek AO, Şirin G, Polat I, Özkan M, Bebek N. The relationship of psychiatric comorbidities and symptoms, quality of life, and stigmatization in patients with epilepsy. Epilepsy Behav 2024; 156:109838. [PMID: 38768552 DOI: 10.1016/j.yebeh.2024.109838] [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: 01/23/2024] [Revised: 04/17/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Research around the frequency of psychiatric diseases and psychosocial consequences caused by seizures and stigmatization in patients with epilepsy is important, in terms of multidimensional evaluation of the condition, increasing quality of life, and controlling the frequency of seizures. This prospective study aimed to evaluate relationship between comorbid psychiatric diseases and clinical and sociodemographic data, patients' quality of life and perceived stigma in patients with epilepsy. METHODS In this prospective single-center study, we evaluated clinical and demographic data, and characteristics of epilepsy. We used the Symptom Check List 90-Revised (SCL-90-R) as a screening test for psychiatric comorbidities and the Mini International Neuropsychiatric Interview (MINI) test for patients who had an SCL90-R general symptom index (GSI) score of ≥1. The frequency of psychiatric comorbidities, the association between comorbid psychiatric disorders and quality of life, and the level of stigmatization in patients with epilepsy was assessed using the Quality of Life in Epilepsy Inventory (QOLIE-10) and Perceived Stigma Scale. RESULTS SCL90-R GSI scores of ≥1 were found in 122 of 300 patients. Psychiatric comorbidities were found in 24.8% (n = 69) of patients with epilepsy in the MINI test, major depression was found in 16.9 %, (n = 47), and generalized anxiety disorder was the most common (5.7 %, n = 16). The number of anti-seizure medications (p = 0.007), high seizure frequency (p = 0.01), seizure in previous 12 months (p = 0.003), history of epilepsy surgery (p = 0.032) and psychiatric disease (p < 0.001), and high perceived stigma (p < 0.001) and QOLIE-10 (p < 0.001) scores were all correlated with psychiatric comorbidities. CONCLUSIONS According to the results of our study, an important correlation was determined between psychiatric comorbidities and a history of psychiatric disease, poor quality of life, and high perceived stigma scores in patients with epilepsy. This suggests that screening patients for comorbid psychiatric conditions in epilepsy outpatient clinics is critical, as is establishing a strong collaboration with the psychiatry clinic, to reduce psychosocial issues and the economic burden of stigmatization and improve quality of life.
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Affiliation(s)
- Tural Talıbov
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Meltem İnci
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Rashad Ismayılov
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Sibel Elmas
- Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul, Turkey
| | - Emiralp Büyüktopçu
- Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul, Turkey
| | - Ata Onur Kepenek
- Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul, Turkey
| | - Görkem Şirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Irmak Polat
- Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul, Turkey
| | - Mine Özkan
- Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul, Turkey
| | - Nerses Bebek
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
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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:jnnp-2023-333073. [PMID: 38443157 DOI: 10.1136/jnnp-2023-333073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Padda K, Matthews RE, Karakis I, Hewitt KC, Valentin E, Block C, Shade T, Dickey A, Millis S, Willie JT, Gross RE, Drane DL. Psychiatric changes after stereotactic laser amygdalohippocampotomy for medial temporal lobe epilepsy. Epilepsy Behav 2023; 145:109332. [PMID: 37422933 PMCID: PMC10523400 DOI: 10.1016/j.yebeh.2023.109332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for drug-resistant temporal lobe epilepsy (TLE) that has comparable rates of seizure freedom to traditional open resective TLE surgery. The objective of this study was to determine psychiatric outcome (i.e., depression and anxiety changes, psychosis) after SLAH, to explore possible contributory factors to these changes, and to determine the prevalence of de novo psychopathology. METHODS We explored mood and anxiety in 37 adult patients with TLE undergoing SLAH using the Beck psychiatric symptoms scales (i.e., Beck Depression Inventory-II [BDI-II] and Beck Anxiety Inventory [BAI]) preoperatively and 6 months following surgery. Multivariable regression analysis was conducted to identify predictors of worse depression or anxiety symptoms following SLAH. The prevalence of de novo psychopathology following SLAH was also determined. RESULTS We found a significant decrease in BDI-II (mean decline from 16.3 to 10.9, p = 0.004) and BAI (mean decline from 13.3 to 9.0, p = 0.045) scores following SLAH at the group level. While the rate of resolution of depression (from 62% to 49%) did not achieve statistical significance (p = 0.13, McNemar's), the rate of resolution of anxiety (from 57% to 35%) was statistically significant (p = 0.03, McNemar's). The de novo rate of psychopathology (i.e., new onset depression or anxiety) following SLAH was 1 of 7 (14%). Using a metric of meaningful change rather than complete symptom resolution, 16 of 37 (43%) patients experienced improvement in depression and 6 of 37 (16%) experienced worsening. For anxiety, 14 of 37 (38%) experienced meaningful improvement and 8 of 37 (22%) experienced worsening. Baseline performance on the Beck Scales was the only factor contributing to outcome status. DISCUSSION In one of the first studies to evaluate psychiatric outcomes after SLAH, we found promising overall trends toward stability or significant improvement in symptom burden at the group level for both depression and anxiety. There was also a significant improvement in clinical anxiety, though the decrease in clinical depression was not significant, likely owing to the limitations of sample size. SLAH may improve overall psychiatric symptoms, similarly to traditional resective TLE surgery, but de novo psychopathology and postoperative psychiatric morbidity remain significant issues, and larger samples are necessary to determine causal contributory factors.
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Affiliation(s)
- Karanbir Padda
- Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Rebecca E Matthews
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edward Valentin
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Taylor Shade
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam Dickey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott Millis
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert E Gross
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA; Coulter Department of Biomedical Engineering, Emory University, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.
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4
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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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Halder T, Michl P, Flanagin V, Schenk T. Impaired Emotion Processing and Panic Disorder After Left Anterior Temporal Lobectomy: A Case Report of Successful Psychotherapeutic Intervention. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Over the last decades, brain surgery became a more frequently applied treatment for temporal lobe epilepsy (TLE). Despite its success, several studies found de-novo post-operative psychiatric symptoms in TLE surgery patients. Cognitive behavioural therapy is effective to treat brain healthy psychiatric patients but might not be translatable to patients with resections in emotion regulating networks as these areas seem to be essentially involved in successful psychotherapeutic treatment.
Methods
Here we report the case of a female patient with medically refractory medial temporal lobe epilepsy resulting in left anterior temporal lobectomy at age 35. Post operation she did not show adequate fearful response but at the same time manifested symptoms of a severe panic disorder. We investigated if this patient, despite lesions in emotion-behaviour brain circuits, can benefit from cognitive behavioural therapy.
Results
The intervention, customized to the specific resources and difficulties of the patient, was effective in stopping panic attacks and improving social functioning.
Conclusions
This case shows that MTL brain surgery patients may benefit from CBT and demonstrates the important and if yet still somewhat mysterious role of the amygdala in emotion regulation processes.
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Pintor L. Temporal Lobectomy: Does It Worsen or Improve Presurgical Psychiatric Disorders? Curr Top Behav Neurosci 2022; 55:307-327. [PMID: 33959938 DOI: 10.1007/7854_2021_224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Temporal lobe epilepsy (TLE) is the type of epilepsy most frequently associated with psychiatric morbidity. Respective surgery for focal epilepsy remains the preferred treatment for medically resistant epilepsy. The aim of this chapter is to review what happens with psychiatric disorders once patients have undergone surgery.Early studies demonstrated a post-surgical increase in the incidence rates of anxiety and depressive disorders, while recent studies found that the prevalence of depression and anxiety decreased 12 months after surgery. In spite of this improvement, de novo anxiety and depressive or psychotic cases can be seen. In particular, de novo psychosis ranges from 1% to 14%, with risk factors including bilateral temporal damage, tumors rather than mesial temporal sclerosis, and seizures emerging after surgery again.Personality changes after temporal lobectomy are yet to be established, but decline in schizotypal behavior and neuroticism is the most replicated so far.In children's studies surgery resolved 16% of the participants' psychiatric problems, while 12% presented a de novo psychiatric diagnosis, but further, more conclusive results are needed.The main limitations of these studies are the inconsistent systematic post-surgical psychiatric evaluations, the small sample sizes of case series, the short follow-up post-surgical periods, and the small number of controlled studies.A psychiatric assessment should be conducted before surgery, and most of all, patients with a psychiatric history should be followed after surgery.
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Bakhtiar Y, Pratama Brilliantika S, Bunyamin J, Arifin MT, Hardian H, Bintoro AC, Muttaqin Z. Postoperative Evaluation of the Quality of Life, Depression, and Anxiety of Temporal Lobe Epilepsy Cohort: A Single Institute Experience in Indonesia. Front Neurol 2021; 12:708064. [PMID: 34594295 PMCID: PMC8477026 DOI: 10.3389/fneur.2021.708064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Besides seizure control, quality of life (QoL) should be considered as an equally important outcome for epilepsy surgery service providers. The paucity of QoL reports from developing countries has enlarged the representation gap between wealthy countries and countries with fewer resources. In this study, we evaluated postoperative QoL in the Indonesian drug-resistant epilepsy cohort where the epilepsy surgery service faces limited resource availability. Methods: We evaluated the QoL in patients with temporal lobe epilepsy who underwent surgery in our epilepsy surgery center in Semarang, Indonesia, from 2001 until 2015. The follow–up period started in 2018 through 2019. Postoperative QoL, depression, and anxiety were evaluated with self-reporting questionnaires including the Quality of Life in Epilepsy Inventory-31, Beck Depression Inventory-II, and Zung Self-Rating Anxiety Scales. Results: Forty returned questionnaires were included in the analysis (male 25, 62.5%; mean age 27.6 ± 9.05 years). The seizure-free cohort (n = 22, 55.0%) reported higher scores in most QoL dimensions particularly adjustment, overall QoL, and seizure worry compared to those with persistent seizures. The overall QoL level was correlated with seizure freedom and surgery type. QoL dimensions were negatively correlated with anxiety and depression levels. Conclusions: Postoperative seizure freedom was a major factor of postoperative QoL level. Besides seizure freedom, anxiety and depression levels were also negatively correlated with QoL levels in the Indonesian population.
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Affiliation(s)
- Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia.,Department of Physiology, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Surya Pratama Brilliantika
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
| | - Muhammad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
| | - Hardian Hardian
- Department of Physiology, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
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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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Gravel V, Boucher O, Citherlet D, Hébert-Seropian B, Bouthillier A, Nguyen DK. Psychological status after insulo-opercular resection in patients with epilepsy: Depression, anxiety, and quality of life. Epilepsy Behav 2021; 118:107919. [PMID: 33770610 DOI: 10.1016/j.yebeh.2021.107919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
Insular epilepsy is increasingly recognized in epilepsy surgery centers. Recent studies suggest that resection of an epileptogenic zone that involves the insula as a treatment for drug-resistant seizures is associated with good outcomes in terms of seizure control. However, despite the existing evidence of a role of the insula in emotions and affective information processing, the long-term psychological outcome of patients undergoing these surgeries remain poorly documented. A group of 27 adults (18 women) who underwent an insulo-opercular resection (in combination with a part of the temporal lobe in 10, and of the frontal lobe in 5) as part of epilepsy surgery at our center between 2004 and 2019 completed psychometric questionnaires to assess depression (Beck Depression Inventory - 2nd edition; BDI-II), anxiety (State-Trait Anxiety Inventory, Trait Version; STAI-T), and quality of life (Patient Weighted Quality of Life In Epilepsy; QOLIE-10-P). Scores were compared to those of patients who had standard temporal lobe epilepsy (TLE) surgery with similar socio-demographic and disease characteristics. Seizure control after insular epilepsy surgery was comparable to that observed after TLE surgery, with a majority of patients reporting being seizure free (insular: 63.0%; temporal: 63.2%) or having rare disabling seizures (insular: 7.4%; temporal: 18.4%) at the time of questionnaire completion. Statistical comparisons revealed no significant group difference on scores of depression, anxiety, or quality of life. Hemisphere or extent of insular resection had no significant effect on the studied variables. In the total sample, employment status and seizure control, but not location of surgery, significantly predicted quality of life. Self-reported long-term psychological status after insulo-opercular resection as part of epilepsy surgery thus appears to be similar to that observed after TLE surgery, which is commonly performed in epilepsy surgery centers.
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Affiliation(s)
- Victoria Gravel
- Département de psychologie, Université de Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada
| | - Olivier Boucher
- Département de psychologie, Université de Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Service de psychologie, Centre hospitalier de l'Université de Montréal, Canada
| | - Daphné Citherlet
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Département de neurosciences, Université de Montréal, Canada
| | - Benjamin Hébert-Seropian
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Département de psychologie, Université du Québec à Montréal, Canada
| | - Alain Bouthillier
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Service de neurochirurgie, Centre hospitalier de l'Université de Montréal, Canada
| | - Dang Khoa Nguyen
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Département de neurosciences, Université de Montréal, Canada; Service de neurologie, Centre hospitalier de l'Université de Montréal, Canada.
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Resective epilepsy surgery in patients aged 50years and older - a retrospective study regarding seizure outcome, memory performance, and psychopathology. Epilepsy Behav 2021; 118:107933. [PMID: 33839451 DOI: 10.1016/j.yebeh.2021.107933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess clinical and demographic characteristics in two cohorts of elderly patients with drug-resistant focal epilepsy, undergoing resective epilepsy surgery (RES). Further, to determine seizure, neuropsychological, and mental health outcomes after RES and evaluate possible influencing factors. METHODS Consecutive patients aged ≥50 years with temporal lobe epilepsy (TLE) who underwent curative RES in the Hamburg epilepsy surgery program (2004-2017) were identified. Data were retrospectively analyzed. Seizure outcome was classified according to ILAE and Engel outcome scales in patients with first-time surgeries and with reoperations. Previously reported predictors of the seizure outcome were evaluated using regression analyses. Changes in verbal memory were assessed for patients with complete pre- and postoperative datasets (n=30) using repeated-measures analysis of variance. For evaluation of possible predictors of psychopathologic changes after RES a regression analysis was conducted. RESULTS Fifty-one elderly patients underwent RES of the temporal lobe, including twelve aged ≥60 years, and five with reoperations. After one year, 65% of the patients with first-time surgeries were seizure free and 91% had a favorable outcome. At last follow-up, 49% were seizure free since surgery. Three reoperated patients had an Engel I outcome. Seizure outcome was not dependent on age at surgery, duration of epilepsy, or other evaluated variables. There was no significant decline in the memory performance after surgery. Significant improvements in mental health were found. CONCLUSION RES for drug-resistant TLE is safe, effective, and improves mental health also in patients aged ≥ 50 years. Thus, it should be evaluated as the treatment of choice also in this age group.
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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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Radaelli G, Majolo F, Leal-Conceição E, de Souza Santos F, Escobar V, Zanirati GG, Portuguez MW, Scorza FA, da Costa JC. Left Hemisphere Lateralization of Epileptic Focus Can Be More Frequent in Temporal Lobe Epilepsy Surgical Patients with No Consensus Associated with Depression Lateralization. Dev Neurosci 2021; 43:1-8. [PMID: 33789300 DOI: 10.1159/000513537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is considered to be the most common form of epilepsy, and it has been seen that most patients are refractory to antiepileptic drugs. A strong association of this ailment has been established with psychiatric comorbidities, primarily mood and anxiety disorders. The side of epileptogenic may contribute to depressive and anxiety symptoms; thus, in this study, we performed a systematic review to evaluate the prevalence of depression in TLE in surgical patients. The literature search was performed using PubMed/Medline, Web of Science, and PsycNet to gather data from inception until January 2019. The search strategy was related to TLE, depressive disorder, and anxiety. After reading full texts, 14 articles meeting the inclusion criteria were screened. The main method utilized for psychiatric diagnosis was Diagnostic and Statistical Manual of Mental Disorders/Structured Clinical Interview for DSM. However, most studies failed to perform the neuropsychological evaluation. For those with lateralization of epilepsy, focus mostly occurred in the left hemisphere. For individual depressive diagnosis, 9 studies were evaluated, and 5 for anxiety. Therefore, from the data analyzed in both situations, no diagnosis was representative in preoperative and postoperative cases. In order to estimate the efficacy of surgery in the psychiatry episodes and its relation to seizure control, the risk of depression and anxiety symptoms in epileptic patients need to be determined before surgical procedures. Rigorous preoperative and postoperative evaluation is essential for psychiatry conditions in patients with refractory epilepsy candidates for surgery.
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Affiliation(s)
- Graciane Radaelli
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Majolo
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Post-graduate Program in Biotechnology, Universidade do Vale do Taquari - Univates, Lajeado, Brazil
| | - Eduardo Leal-Conceição
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Francisco de Souza Santos
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vinícius Escobar
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriele Goulart Zanirati
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mirna Wetters Portuguez
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fulvio Alexandre Scorza
- Department of Neurology and Neurosurgery, Laboratory of Neuroscience, Federal University of São Paulo, São Paulo, Brazil.,Researcher from CNPq, Porto Alegre, Brazil
| | - Jaderson Costa da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Researcher from CNPq, Porto Alegre, Brazil
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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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14
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Abstract
OBJECTIVES There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. METHODS This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. RESULTS There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). CONCLUSIONS This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.
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15
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Gabriel D, Ventura M, Samões R, Freitas J, Lopes J, Ramalheira J, Martins da Silva A, Chaves J. Social impairment and stigma in genetic generalized epilepsies. Epilepsy Behav 2020; 104:106886. [PMID: 31931462 DOI: 10.1016/j.yebeh.2019.106886] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Patients with epilepsy have poor social outcome. Multifactorial factors are usually involved, but among them, stigma features may have an important role. Genetic generalized epilepsies (GGEs) were previously considered "benign" syndromes. The aim of our study was to assess social impairment and stigma in GGE and to evaluate differences between the following GGE subsyndromes: juvenile myoclonic epilepsy (JME), juvenile absence epilepsy (JAE), and generalized tonic-clonic seizures alone (GTCSA). Additionally, we compared these outcomes with outcomes from a cohort of patients with epilepsy with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), a severe and difficult-to-treat syndrome. Results were compared with social data from the general population. METHODS Adult patients with epilepsy with a previously classified GGE or MTLE-HS were consecutively invited to fill in a sociodemographic and stigma questionnaire in outpatient clinic. Clinical data and psychiatric comorbidities were retrieved from clinical notes. RESULTS Questionnaires from 333 patients were obtained: 226/67% from patients with GGE (JME: 106/31.8%, GTCSA: 74/22.2%, and JAE: 46/13.8%) and 107/32.1% from patients with MTLE-HS. We found that patients with GGE have a good academic achievement but they have increased difficulties in finding a partner, higher rates of divorce, and a reduced number of children per woman and per man when compared with general population. We also observed that patients with GGE have higher rates of unemployment (22.6%) and lower monthly income than general population. Severe problems in housing were only seen in GGEs. Of these, 3 patients (1.3%) were in homeless condition. Over half (52%) of patients with MTLE-HS and over a quarter (28%) of patients with GGE experienced felt stigma. Psychiatric comorbidity was highly prevalent among GGE (34.1%), especially in patients with refractory epilepsy. Mood and anxiety disorders were the most prevalent conditions. No other significant differences were found between GGE subsyndromes. DISCUSSION We found an impairment in every social domain assessed (except in level of education) when compared with general population. Most of the social outcome parameters were unexpectedly close or similar to MTLE-HS or even worse as it was the prevalence of homelessness among GGE. Social impairment is underdiagnosed and might be considered in clinical practice even in syndromes for some time considered benign such as GGE.
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Affiliation(s)
- Denis Gabriel
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - Magda Ventura
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Raquel Samões
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Joel Freitas
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - João Lopes
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - João Ramalheira
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - António Martins da Silva
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - João Chaves
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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16
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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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17
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Lebedeva AV, Avedisova AS, Kustov GV, Gersamiya AG, Kaymovskiy IL, Rider FK, Trifonov IS, Pashnin EV, Malkhasyan EA, Guekht AB, Krylov VV. [Prognosis for surgical treatment of pharmacoresistant epilepsy: the role of mental and cognitive disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:27-36. [PMID: 30698541 DOI: 10.17116/jnevro201811810227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This review focuses on the role of mental and cognitive disorders in the prognosis for surgical treatment of pharmacoresistant epilepsy. The authors analyze historical aspects of the surgical treatment of epilepsy and present current data on the prognosis of operative intervention with respect to seizure control, cognitive functioning, and psychiatric disorders. The psychiatrist's role in the structure of preoperative and postoperative management of patients is considered.
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Affiliation(s)
- A V Lebedeva
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - A S Avedisova
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - G V Kustov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - A G Gersamiya
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | | | - F K Rider
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - I S Trifonov
- Evdokimov Moscow State University of Medical Dentisitry, Moscow, Russia
| | - E V Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - E A Malkhasyan
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - A B Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - V V Krylov
- Evdokimov Moscow State University of Medical Dentisitry, Moscow, Russia; Sklifosovsky Research Institute of Emergensy Medicine, Moscow, Russia
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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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A right amygdalohippocampectomy: A diagnostic challenge. Clin Neurol Neurosurg 2017; 164:57-63. [PMID: 29175724 DOI: 10.1016/j.clineuro.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Amygdalohippocampectomy (AHE) is the resective surgery for medically intractable mesial temporal lobe epilepsy. To date no study has investigated a wide range of neuropsychiatric symptoms in right AHE outpatients. PATIENTS AND METHODS Three patients with right AHE participated in this study. The control group are patients with cognitive complaints with no history of epilepsy or neurological impairment and no structural abnormalities on the MRI/CT. We expected no difference in verbal memory compared to the controls. Concerning affective Theory of Mind (ToM) we expect a difference between controls and AHE patients. In terms of behavior it is expected that coping and behavioral questionnaires do not significantly differ between AHE and controls, but that proxies of AHE patients do report more behavioral/psychiatric symptoms. RESULTS No significant difference was found between groups concerning the cognitive functions. For affective ToM we did find a significant difference (p=0.044). A significant difference for the use of more reassuring thoughts (p=0.006) and a trend for less passive reactions on the coping questionnaire, suggesting an 'active coping style'. Overall, AHE patients report fewer problems the self- reported questionnaires. Proxies of the AHE patients reported a trend for more behavioral disinhibition compared to proxy ratings of the control group. CONCLUSION Right AHE patients underestimate their behavioral and emotional changes due to self-awareness deficits. Ratings of significant others are of immense importance for the detection of psychiatric and behavioral problems. Lesions in the amygdala- orbitofrontal cortex connection disrupt the emotional network, which might explain our results.
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Baldin E, Hauser WA, Pack A, Hesdorffer DC. Stress is associated with an increased risk of recurrent seizures in adults. Epilepsia 2017; 58:1037-1046. [DOI: 10.1111/epi.13741] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Elisa Baldin
- Gertrude H. Sergievsky Center; Columbia University; New York New York U.S.A
- IRCCS Institute of Neurological Sciences of Bologna; Bologna Italy
| | - W. Allen Hauser
- Gertrude H. Sergievsky Center; Columbia University; New York New York U.S.A
- Department of Neurology; College of Physicians and Surgeons; Columbia University; New York New York U.S.A
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York New York U.S.A
| | - Alison Pack
- Department of Neurology; College of Physicians and Surgeons; Columbia University; New York New York U.S.A
| | - Dale C. Hesdorffer
- Gertrude H. Sergievsky Center; Columbia University; New York New York U.S.A
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York New York U.S.A
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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: 21] [Impact Index Per Article: 2.6] [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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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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Barbieri V, Cardinale F, Gozzo F, Pelliccia V, Nobili L, Casaceli G, Fuschillo D, Castana L, Cossu M, Lo Russo G, Tassi L, Gambini O. Risk factors for postoperative depression: A retrospective analysis of 248 subjects operated on for drug-resistant epilepsy. Epilepsia 2015; 56:e149-55. [DOI: 10.1111/epi.13118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Francesco Cardinale
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Francesca Gozzo
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Veronica Pelliccia
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Lino Nobili
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Giuseppe Casaceli
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Dalila Fuschillo
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Laura Castana
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Massimo Cossu
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Giorgio Lo Russo
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Laura Tassi
- “Claudio Munari” Center for Epilepsy and Parkinson Surgery; Niguarda Ca' Granda Hospital; Milan Italy
| | - Orsola Gambini
- Psychiatric Branch; San Paolo Hospital, Milan; Milano Italy
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de Araujo Filho GM, Furlan AER, Ribeiro AESA, Marques LHN. Psychiatric disorders as "hidden" contraindications for presurgical VEEG in patients with refractory epilepsy: A retrospective cohort study in a tertiary center. Epilepsy Behav 2015; 45:35-8. [PMID: 25801752 DOI: 10.1016/j.yebeh.2015.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/20/2015] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
Abstract
Given the high frequency of psychiatric disorders (PDs) observed among patients with epilepsy, studies have highlighted the necessity of psychiatric evaluation for these patients, especially for those with refractory temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS) who are surgical candidates. Current evidence highlights the safety of video-electroencephalography (VEEG) as a means of investigation in patients with TLE-MTS and PDs. However, the presence of such disorders has still been seen as a contraindication for presurgical evaluation with VEEG in some epilepsy centers mainly because of the risk of negative behavioral events. The present retrospective cohort study performed in a Brazilian tertiary epilepsy center aimed to identify whether the presence of a PD remains a contraindication for presurgical VEEG. Clinical, sociodemographic, and psychiatric data from 41 patients who underwent VEEG as part of their presurgical evaluation were compared to data from 32 patients with refractory TLE-MTS who had not undergone VEEG. Psychiatric diagnoses were determined using the DSM-IV and ILAE criteria. Psychiatric disorders were diagnosed in 34 patients (46.6%). Major depressive disorder was the most frequent PD and was observed in 22 patients (30.1%). Anxiety disorders were observed in 14 patients (19.2%). Of the 41 patients (56.2%) who underwent presurgical VEEG, only 12 (29.2%) were found to have a PD during the presurgical psychiatric evaluation compared to 22 of the 32 (68.7%) who did not undergo VEEG (p=0.001; RR=2.35). The present findings suggest that the presence of a PD alone should not be a contraindication for VEEG monitoring and epilepsy surgery.
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Affiliation(s)
- Gerardo Maria de Araujo Filho
- Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil.
| | - Ana Eliza Romano Furlan
- Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| | - Ana Elisa Sa Antunes Ribeiro
- Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| | - Lucia Helena Neves Marques
- Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
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Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J Neurol Sci 2014; 340:183-90. [DOI: 10.1016/j.jns.2014.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022]
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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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Cleary RA, Baxendale SA, Thompson PJ, Foong J. Predicting and preventing psychopathology following temporal lobe epilepsy surgery. Epilepsy Behav 2013; 26:322-34. [PMID: 23246146 DOI: 10.1016/j.yebeh.2012.09.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 11/17/2022]
Abstract
Less than 3% of temporal lobe epilepsy (TLE) surgical outcome studies have investigated the psychiatric sequelae and morbidity associated with surgery. This is disproportionate to the extent of the problem. Variable prevalence rates have been reported for post-surgical depression, anxiety, and interictal psychosis. Until recently, very few studies distinguished de novo postoperative presentations from pre-existing conditions, making it difficult to accurately assess the impact of TLE surgery on psychiatric morbidity. Predictors of de novo postoperative presentations have proved elusive. This current review summarizes the findings from a systematic literature review of the psychiatric morbidity associated with TLE surgery including newly published follow-up data from our own series of 280 surgical patients. A framework for future research, possible pathophysiological mechanisms, and translational models are also discussed.
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Affiliation(s)
- Rebecca A Cleary
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, UK.
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Preoperative depressive symptoms are not predictors of postoperative seizure control in patients with mesial temporal lobe epilepsy and hippocampal sclerosis. Epilepsy Behav 2013; 26:81-6. [PMID: 23247268 DOI: 10.1016/j.yebeh.2012.06.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/04/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022]
Abstract
Retrospective data analysis was performed in a sample of 45 consecutive patients who underwent epilepsy surgery for medically refractory mTLE-HS. Beck Depression Inventory (BDI) was used preoperatively to detect actual depressive symptoms and label patients into those "with depressive symptoms" or "without depressive symptoms". Postoperative seizure outcome one, two, and three years after surgery was classified into "complete seizure freedom" versus "presence of auras and/or seizures". Postoperative seizure outcomes were compared in patients with and without depressive symptoms, and no significant difference of postoperative seizure outcome was found. However, there was a non-significant trend for patients with preoperative depressive symptoms to experience a postoperative running down phenomenon more frequently than nondepressed patients. Depressive symptoms, identified by the BDI, do not seem to have a predictive value for postoperative seizure outcome in this highly selected patient population with mTLE-HS, but may be positive predictors for experiencing a postoperative running down phenomenon.
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Filho GMDA, Mazetto L, Gomes FL, Marinho MM, Tavares IM, Caboclo LOSF, Centeno RS, Yacubian EMT. Pre-surgical predictors for psychiatric disorders following epilepsy surgery in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis. Epilepsy Res 2012; 102:86-93. [DOI: 10.1016/j.eplepsyres.2012.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/25/2012] [Accepted: 05/13/2012] [Indexed: 11/24/2022]
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de Araújo Filho GM, Gomes FL, Mazetto L, Marinho MM, Tavares IM, Caboclo LOSF, Yacubian EMT, Centeno RS. Major depressive disorder as a predictor of a worse seizure outcome one year after surgery in patients with temporal lobe epilepsy and mesial temporal sclerosis. Seizure 2012; 21:619-23. [DOI: 10.1016/j.seizure.2012.07.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 07/04/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022] Open
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Araújo Filho GMD, Gomes FL, Mazetto L, Marinho MM, Tavares IM, Caboclo LOSF, Yacubian EMT, Centeno RS. Pre-surgical mood disorders associated to worse post-surgical seizure outcome in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis. ACTA ACUST UNITED AC 2012. [DOI: 10.1590/s1676-26492012000100006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES: This study aims at verifying the impact of pre-surgical PD on seizure outcome in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS). METHODS: After previous consent, retrospective data from 115 surgically treated (corticoamygdalohyppocampectomy) TLE-MTS patients (65 females; 56.5%) were analyzed. Psychiatric evaluations were performed through DSM-IV criteria. Engel IA was established as a favorable prognosis. RESULTS: Forty-five patients (41.6%) were classified as Engel IA, while 47 (40.8%) presented pre-surgical PD. Depression (OR=5.11; p=0.004) appeared as a risk factor associated to a non-favorable seizure outcome. CONCLUSION: In patients with refractory TLE-MTS, the presence of depression predicts an unfavorable outcome.
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Affiliation(s)
| | | | - Lenon Mazetto
- Universidade Federal de São Paulo, Brazil; Universidade Federal de São Paulo, Brazil
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Macrodimitris S, Sherman EMS, Forde S, Tellez-Zenteno JF, Metcalfe A, Hernandez-Ronquillo L, Wiebe S, Jetté N. Psychiatric outcomes of epilepsy surgery: A systematic review. Epilepsia 2011; 52:880-90. [DOI: 10.1111/j.1528-1167.2011.03014.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Risk factors for postoperative depression in 150 subjects treated for drug-resistant focal epilepsy. Epidemiol Psychiatr Sci 2011; 20:99-105. [PMID: 21657120 DOI: 10.1017/s2045796011000175] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The primary goal was to identify risk factors for post-surgical depression in subjects operated on for drug-resistant epilepsy. Secondary goals were to confirm the high rate of depression in subjects suffering from epilepsy (prior to surgery) and to look for first post-surgical depressive episode. METHODS Case series study of 150 subjects surgically treated for partial epilepsy (side of surgery: 72 right, 78 left; site of surgery: 97 Unilobar Temporal, 17 Unilobar Frontal, 14 Posterior, 22 Multilobar). All subjects routinely had three psychiatric evaluations: before surgery (baseline) and at 6 and 12 months after surgery. Psychiatric diagnoses were made according to DSM-IV-TR criteria. Bivariate (Fisher exact test and Kruskal-Wallis rank sum test) and multivariate (logistic regression model fitting) analyses were performed. RESULTS Thirty-three (22%) subjects had post-surgical depressive episodes, 31 of them in the first 6 months. Fourteen out of 33 experienced depression for the first time. Post-surgical depressive episodes are not associated with gender, outcome on seizures, side/site of surgical resection, histological diagnosis, psychiatric diagnoses other than depression. Depressive episodes before surgery and older age at surgery time are risk factors for post-surgical depression (p= 0.0001 and 0.01, respectively, at logistic regression analysis). No protective factors were identified. CONCLUSIONS Our data show that lifetime depressive episodes and older age at surgery time are risk factors for postsurgery depression. Moreover, a prospective study could be useful in order to assess whether depression is really a consequence of surgery.
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Desai SD, Shukla G, Goyal V, Singh S, Padma MV, Tripathi M, Srivastava A, Singh M, Shivakumar K, Sagar R, Behari M. Study of DSM-IV Axis I psychiatric disorders in patients with refractory complex partial seizures using a short structured clinical interview. Epilepsy Behav 2010; 19:301-5. [PMID: 20728411 DOI: 10.1016/j.yebeh.2010.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 07/01/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
Psychiatric disorders are a source of significant comorbidity in patients with refractory epilepsy, yet are often underrecognized. We assessed the prevalence of DSM-IV Axis I psychiatric disorders using a short structured clinical interview (Mini-International Psychiatric Interview [MINI]) in patients with medically refractory complex partial seizures. Consecutive patients with refractory epilepsy being evaluated with video/EEG monitoring and imaging for seizure focus localization and lateralization underwent MINI evaluation to assess for the presence of psychiatric disorders. Among 117 patients (74 male, 43 female) studied, 57 (48.7%) had at least one psychiatric disorder; 19 (16.2%) had depression, 10 (8.5%) dysthymia, 27 (23.0%) anxiety disorder, and 11(9.4%) other disorders. Most clinical features and epilepsy-related variables had no significant association with psychiatric disorder on logistic regression analysis. Almost half of the patients with refractory focal seizures have a coexistent psychiatric disorder, and its presence or absence cannot be predicted by their clinical profiles. All patients should be assessed and treated for psychiatric comorbidity to improve overall quality of life.
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Affiliation(s)
- Soaham D Desai
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Sanchez-Gistau V, Pintor L, Sugranyes G, Baillés E, Carreño M, Donaire A, Boget T, Setoain X, Bargalló N, Rumia J. Prevalence of interictal psychiatric disorders in patients with refractory temporal and extratemporal lobe epilepsy in Spain. A comparative study. Epilepsia 2009; 51:1309-13. [PMID: 20041944 DOI: 10.1111/j.1528-1167.2009.02464.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We aim to investigate whether temporal origin of epilepsy increases the risk of developing a psychiatric disorder and more specifically a major depressive disorder. The lack of standardized diagnostic instruments and the methodologic differences between studies highlight the fact that this issue warrants further, systematic, study. Three-hundred eight patients with complex partial seizures were classified according to temporal or extratemporal origin, following the Commission on Classification and Terminology of the International League Against Epilepsy (ILAE), 1989 localization-related concept. All patients were assessed using the Structured Interview for DSM-IV axis I psychiatric disorders (SCID-I). Lifetime and previous-year prevalence of psychiatric disorders were compared in temporal and extratemporal subgroups, using multivariate analysis. Previous-year major depression was significantly associated with temporal lobe origin. Our results do not support the hypothesis that patients with temporal lobe epilepsy (TLE) have more psychiatric illness in general, although they do suggest a specific connection between TLE and major depression.
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Affiliation(s)
- Vanessa Sanchez-Gistau
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Villarroel, Spain.
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Moss K, O'Driscoll K, Eldridge P, Varma T, Wieshmann UC. Risk factors for early post-operative psychiatric symptoms in patients undergoing epilepsy surgery for temporal lobe epilepsy. Acta Neurol Scand 2009; 120:176-81. [PMID: 19486325 DOI: 10.1111/j.1600-0404.2008.01149.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE De-novo psychiatric symptoms may develop within 3 months after a temporal lobectomy for epilepsy. The objective of this study was to identify presurgical risk factors for psychiatric symptoms. METHODS Twenty-seven patients who had a temporal lobectomy for epilepsy were included. Twenty-four had hippocampal sclerosis or gliosis, and three had cavernous haemagiomata. Twelve had operations on the left, and 15 on the right side. Twenty-four patients were rendered free of seizures (SZ) with loss of awareness, three had early post-operative convulsions, one continued to have habitual SZ. RESULTS Nine patients (33%) developed low mood, anxiety and emotional lability within 3 months after surgery. Patients with early post-operative psychiatric symptoms were younger (27.9/34.8 years, P = 0.01), and more anxious on the presurgical Hospital Anxiety and Depression Scale (12/8.44, P = 0.02) than patients without post-operative psychiatric symptoms. There was also an association between right temporal lobectomies and early post-surgical symptoms (P = 0.02 Fisher's exact test). CONCLUSION Potential risk factors were age, anxiety and operation on the right side. Larger studies are required to determine if these risk factors are independent.
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Affiliation(s)
- K Moss
- Department of Neurology, Liverpool, UK
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Abstract
OBJECTIVE: The purpose of this study was to evaluate the patients' life adjustment after epilepsy surgery, through instruments of quality of life (QoL), anxiety, depression, preoperative expectations and postoperative life changing. METHODS: Thirty-six adults who underwent temporal lobe epilepsy surgery were interviewed before surgery, and 6 and 12 months after surgery. RESULTS: For all patients, epilepsy surgery gave rise to an evolving process of postoperative adjustment, what means that they were satisfied with surgery results, and that their expectations were reached. The improvement was seen in their QoL (p=0.004), anxiety (p=0.019) and depression (p=0.001), which was associated to their perception of positive life changing. The inexistence of depressive and anxiety symptoms and the good QoL after surgery predicted the perception of positive life changing. This study could predict a total of 56.5% of aspects involved in the perception of positive life changing after epilepsy surgery, what seems that other variables may be involved in this process. The patients' status before surgery (expectations, QoL, anxiety, depression and seizures frequency) did not predict the life satisfaction after surgery, what means that when patients evaluate their actual lives they do it looking for daily aspects and do not tend to compare to their lives before surgery. CONCLUSION: The findings of the present study have implications for the evaluation of life adjustment postsurgery, calling attention to measures of preoperative expectations, anxiety, depression and QoL. The strength of these contributions highlights the importance of registering the patients' feelings and opinions during the presurgical evaluation and may help the health providers to understand the aspects necessary to improve the patients' quality of life.
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Abstract
Surgery is widely accepted as an effective therapy for selected individuals with medically refractory epilepsy. Numerous studies in the past 20 years have reported seizure freedom for at least 1 year in 53-84% of patients after anteromesial temporal lobe resections for mesial temporal lobe sclerosis, in 66-100% of patients with dual pathology, in 36-76% of patients with localised neocortical epilepsy, and in 43-79% of patients after hemispherectomies. Reported rates for non-resective surgery have been less impressive in terms of seizure freedom; however, the benefit is more apparent when reported in terms of significant seizure reductions. In this Review, we consider the outcomes of surgery in adults and children with epilepsy and review studies of neurological and cognitive sequelae, psychiatric and behavioural outcomes, and overall health-related quality of life.
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Chapter 20 Psychiatric Comorbidities in Epilepsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2008; 83:347-83. [DOI: 10.1016/s0074-7742(08)00020-2] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kondziella D, Alvestad S, Vaaler A, Sonnewald U. Which clinical and experimental data link temporal lobe epilepsy with depression? J Neurochem 2007; 103:2136-52. [PMID: 17887964 DOI: 10.1111/j.1471-4159.2007.04926.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The association of temporal lobe epilepsy with depression and other neuropsychiatric disorders has been known since the early beginnings of neurology and psychiatry. However, only recently have in vivo and ex vivo techniques such as Positron Emission Tomography, Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy in combination with refined animal models and behavioral tests made it possible to identify an emerging pattern of common pathophysiological mechanisms. We now have growing evidence that in both disorders altered interaction of serotonergic and noradrenergic neurons with glutamatergic systems is associated with abnormal neuronal circuits and hyperexcitability. Neuronal hyperexcitability can possibly evoke seizure activity as well as disturbed emotions. Moreover, decreased synaptic levels of neurotransmitters and high glucocorticoid levels influence intracellular signaling pathways such as cAMP, causing disturbances of brain-derived and other neurotrophic factors. These may be associated with hippocampal atrophy seen on Magnetic Resonance Imaging and memory impairment as well as altered fear processing and transient hypertrophy of the amygdala. Positron Emission Tomography studies additionally suggest hypometabolism of glucose in temporal and frontal lobes. Last, but not least, in temporal lobe epilepsy and depression astrocytes play a role that reaches far beyond their involvement in hippocampal sclerosis and ultimately, therapeutic regulation of glial-neuronal interactions may be a target for future research. All these mechanisms are strongly intertwined and probably bidirectional such that the structural and functional alterations from one disease increase the risk for developing the other. This review provides an integrative update of the most relevant experimental and clinical data on temporal lobe epilepsy and its association with depression.
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Affiliation(s)
- Daniel Kondziella
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Jones JE, Bell B, Fine J, Rutecki P, Seidenberg M, Hermann B. A controlled prospective investigation of psychiatric comorbidity in temporal lobe epilepsy. Epilepsia 2007; 48:2357-60. [PMID: 17651410 DOI: 10.1111/j.1528-1167.2007.01217.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Temporal lobe epilepsy patients (n = 48) and healthy controls (n = 69) underwent structured psychiatric interview at baseline and 4 years later to characterize the course of DSM-IV Axis I disorders. Adjusting for the influence of prior psychiatric history, epilepsy subjects exhibit significantly greater risk of interval episodes of Total Axis I Disorders and Mood Disorders, indicating a poorer prognosis for these comorbidities in the context of chronic temporal lobe epilepsy.
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Affiliation(s)
- Jana E Jones
- Department of Neurology and Biostatistics, University of Wisconsin, Madison, Wisconsin 53792, USA.
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