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Kellogg MA, Ernst LD, Spencer DC, Datta P, Klein E, Bhati MT, Shivacharan RS, Nho YH, Barbosa DAN, Halpern CH, Raslan A. Dual Treatment of Refractory Focal Epilepsy and Obsessive-Compulsive Disorder With Intracranial Responsive Neurostimulation. Neurol Clin Pract 2024; 14:e200318. [PMID: 38846467 PMCID: PMC11152646 DOI: 10.1212/cpj.0000000000200318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/02/2024] [Indexed: 06/09/2024]
Abstract
Purpose of the Review Intracranial neurostimulation is a well-established treatment of neurologic conditions such as drug-resistant epilepsy (DRE) and movement disorders, and there is emerging evidence for using deep brain stimulation to treat obsessive-compulsive disorder (OCD) and depression. Nearly all published reports of intracranial neurostimulation have focused on implanting a single device to treat a single condition. The purpose of this review was to educate neurology clinicians on the background literature informing dual treatment of 2 comorbid neuropsychiatric conditions epilepsy and OCD, discuss ethical and logistical challenges to dual neuropsychiatric treatment with a single device, and demonstrate the promise and pitfalls of this approach through discussion of the first-in-human closed-looped responsive neurostimulator (RNS) implanted to treat both DRE (on-label) and OCD (off-label). Recent Findings We report the first implantation of an intracranial closed-loop neurostimulation device (the RNS system) with the primary goal of treating DRE and a secondary exploratory goal of managing treatment-refractory OCD. The RNS system detects electrophysiologic activity and delivers electrical stimulation through 1 or 2 electrodes implanted into a patient's seizure-onset zones (SOZs). In this case report, we describe a patient with treatment-refractory epilepsy and OCD where the first lead was implanted in the right superior temporal gyrus to target the most active SOZ based on stereotactic EEG (sEEG) recordings and semiology. The second lead was implanted to target the right anterior peri-insular region (a secondary SOZ on sEEG) with the distal-most contacts in the right nucleus accumbens, a putative target for OCD neurostimulation treatment. The RNS system was programmed to detect and record the unique electrophysiologic signature of both the patient's seizures and compulsions and then deliver tailored electrical pulses to disrupt the pathologic circuitry. Summary Dual treatment of refractory focal epilepsy and OCD with an intracranial closed-loop neurostimulation device is feasible, safe, and potentially effective. However, there are logistical challenges and ethical considerations to this novel approach to treatment, which require complex care coordination by a large multidisciplinary team.
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Affiliation(s)
- Marissa A Kellogg
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Lia D Ernst
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - David C Spencer
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Proleta Datta
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Eran Klein
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Mahendra T Bhati
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Rajat S Shivacharan
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Young-Hoon Nho
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Daniel A N Barbosa
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Casey H Halpern
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Ahmed Raslan
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
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Viola V, Bisulli F, Cornaggia CM, Ferri L, Licchetta L, Muccioli L, Mostacci B. Personality disorders in people with epilepsy: a review. Front Psychiatry 2024; 15:1404856. [PMID: 38800062 PMCID: PMC11116589 DOI: 10.3389/fpsyt.2024.1404856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Epileptologists and psychiatrists have long observed a correlation between epilepsy and personality disorders (PDs) in their clinical practice. We conducted a comprehensive PubMed search looking for evidence on PDs in people with epilepsy (PwE). Out of over 600 results obtained without applying any time restriction, we selected only relevant studies (both analytical and descriptive) limited to English, Italian, French and Spanish languages, with a specific focus on PDs, rather than traits or symptoms, thus narrowing our search down to 23 eligible studies. PDs have been investigated in focal epilepsy (predominantly temporal lobe epilepsy - TLE), juvenile myoclonic epilepsy (JME) and psychogenic non-epileptic seizures (PNES), with heterogeneous methodology. Prevalence rates of PDs in focal epilepsy ranged from 18 to 42% in surgical candidates or post-surgical individuals, with Cluster C personality disorders or related traits and symptoms being most common. In JME, prevalence rates ranged from 8 to 23%, with no strong correlation with any specific PDs subtype. In PNES, prevalence rates ranged from 30 to 60%, with a notable association with Cluster B personality disorders, particularly borderline personality disorder. The presence of a PD in PwE, irrespective of subtype, complicates treatment management. However, substantial gaps of knowledge exist concerning the neurobiological substrate, effects of antiseizure medications and epilepsy surgery on concomitant PDs, all of which are indeed potential paths for future research.
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Affiliation(s)
- Veronica Viola
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | | | - Lorenzo Ferri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Lorenzo Muccioli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
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Guo X, Lin W, Zhong R, Han Y, Yu J, Yan K, Zhang X, Liang J. Factors related to the severity of obsessive-compulsive symptoms and their impact on suicide risk in epileptic patients. Epilepsy Behav 2023; 146:109362. [PMID: 37499582 DOI: 10.1016/j.yebeh.2023.109362] [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: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To explore relevant factors for the severity of obsessive-compulsive symptoms (OCSs) in adult epileptic patients and investigate whether the severity of OCSs is a mediator in the relationship between depressive/anxiety symptoms and suicide risk in epileptic patients. METHODS This was a cross-sectional study from a hospital in Northeast China. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Neurological Disorders Depression Inventory for Epilepsy (NDDIE), Generalized Anxiety Disorder (GAD-7), and Nurses' Global Assessment of Suicide Risk (NGASR) were used to assess the severity of OCSs, depressive symptoms, anxiety symptoms, and suicide risk in epileptic patients, respectively. The independent factors of the severity of OCSs and their mediating effects in the relationship between depressive/anxiety symptoms and suicide risk were evaluated by regression analyses and mediator models, respectively. RESULTS NDDIE scores (β = 0.404, p < 0.001), GAD-7 scores (β = 0.247, p = 0.009), and polytherapy (β = 0.119, p = 0.032) were the independent factors of Y-BOCS scores. The Y-BOCS scores partially mediated the relationship between GAD-7 scores and NGASR scores (standardized coefficients of indirect effect = 0.109, Bootstrap 95% CI = 0.024 to 0.214). Still, they did not mediate the relationship between NDDIE scores and NGASR scores (standardized coefficients of indirect effect = 0.062, Bootstrap 95% CI = -0.024 to 0.169). CONCLUSIONS Depressive symptoms, anxiety symptoms, and polytherapy are independently associated with the severity of OCSs in epileptic patients. Depressive and anxiety symptoms mediate the effect of the severity of OCSs on suicide risk in epileptic patients completely.
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Affiliation(s)
- Xin Guo
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yujuan Han
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jieyang Yu
- Department of Pediatric Neurology, the First Hospital of Jilin University, Changchun, China
| | - Kangle Yan
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Jianmin Liang
- Department of Pediatric Neurology, the First Hospital of Jilin University, Changchun, China.
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Malekpour M, Jafari A, Kashkooli M, Salarikia SR, Negahdaripour M. A systems biology approach for discovering the cellular and molecular aspects of psychogenic non-epileptic seizure. Front Psychiatry 2023; 14:1116892. [PMID: 37252132 PMCID: PMC10213457 DOI: 10.3389/fpsyt.2023.1116892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Psychogenic non-epileptic seizure (PNES) is the most common non-epileptic disorder in patients referring to epilepsy centers. Contrary to common beliefs about the disease's harmlessness, the death rate of PNES patients is similar to drug-resistant epilepsy. Meanwhile, the molecular pathomechanism of PNES is unknown with very limited related research. Thus, the aim of this in silico study was to find different proteins and hormones associated with PNES via a systems biology approach. Methods Different bioinformatics databases and literature review were used to find proteins associated with PNES. The protein-hormone interaction network of PNES was constructed to discover its most influential compartments. The pathways associated with PNES pathomechanism were found by enrichment analysis of the identified proteins. Besides, the relationship between PNES-related molecules and psychiatric diseases was discovered, and the brain regions that could express altered levels of blood proteins were discovered. Results Eight genes and three hormones were found associated with PNES through the review process. Proopiomelanocortin (POMC), neuropeptide Y (NPY), cortisol, norepinephrine, and brain-derived neurotrophic factor (BDNF) were identified to have a high impact on the disease pathogenesis network. Moreover, activation of Janus kinase-signaling transducer and activator of transcription (JAK-STAT) and JAK, as well as signaling of growth hormone receptor, phosphatidylinositol 3-kinase /protein kinase B (PI3K/AKT), and neurotrophin were found associated with PNES molecular mechanism. Several psychiatric diseases such as depression, schizophrenia, and alcohol-related disorders were shown to be associated with PNES predominantly through signaling molecules. Significance This study was the first to gather the biochemicals associated with PNES. Multiple components and pathways and several psychiatric diseases associated with PNES, and some brain regions that could be altered during PNES were suggested, which should be confirmed in further studies. Altogether, these findings could be used in future molecular research on PNES patients.
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Affiliation(s)
- Mahdi Malekpour
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Jafari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Kashkooli
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Manica Negahdaripour
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Abe D, Inaji M, Hashimoto S, Takagi S, Maehara T. Epilepsy surgery for dominant-side mesial temporal lobe epilepsy without hippocampal sclerosis. J Clin Neurosci 2023; 111:16-21. [PMID: 36921552 DOI: 10.1016/j.jocn.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
Although anterior temporal lobectomy (ATL) is an established surgery for medically intractable mesial temporal lobe epilepsy (MTLE), it can harm memory function, especially in dominant-side MTLE patients without hippocampal sclerosis (HS). To avoid this complication, multiple hippocampal transection (MHT) was developed, but its efficacy has not been fully elucidated. We report the detailed treatment results of MHT compared with that of ATL. We retrospectively analysed the records of 30 patients who underwent surgery for dominant-side MTLE. ATL was completed for 23 patients with HS, and MHT was completed for 7 patients without HS. The seizure control status, number of anti-seizure medicines, neurocognitive function, and psychiatric disorders of each patient were reviewed. The mean follow-up period was 70 months. Seizure control of Engel class I was achieved in 16 patients (70%) in the ALT group versus 5 patients (71%) in the MHT group. The mean number of anti-seizure medicines administered in the ATL group changed significantly from 2.4 to 1.9 (p = 0.01), while that in the MHT group was unchanged (from 2.1 to 2.0, p = 0.77). Eleven patients (48%) in the ATL group developed psychiatric disorders during the postoperative follow-up period, whereas no psychological complications were observed in the MHT group. Neither group showed neurocognitive decline after the surgery in any of the WAIS-III or WMS-R subtests. In conclusion, MHT may achieve reasonable postoperative seizure reduction, preserve neurocognitive function, and reduce postoperative psychiatric complications. Therefore, it can be considered as a therapeutic option for dominant-side MTLE without HS.
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Affiliation(s)
- Daisu Abe
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Satoka Hashimoto
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Takagi
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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Najand B, Christensen A, Martin M, Spelman M. Sleep-deprived electroencephalography, a forgotten investigation in psychiatry; a case series. Int J Psychiatry Med 2023; 58:69-80. [PMID: 35067085 DOI: 10.1177/00912174211068361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many patients with psychiatric disorders may have epileptic disorders; however, clinical diagnosis without imaging investigation may result in misdiagnosis and thus resistance to treatment. We investigated electroencephalography (EEG) abnormalities in the patients with psychiatric disorders referred to us with treatment resistance. METHODS In this case series study, nine patients with mood and psychotic symptoms who were referred to us at Belmont Private Hospital, Australia, from August 2018 to July 2020, were evaluated. RESULTS Complete examination showed the presence of undiagnosed temporal lobe epilepsy. Notably, the seizure symptoms had been assumed as part of other psychiatric co-morbidities. CONCLUSIONS This study suggests the necessity of paying attention to the biological etiologies of mental illnesses in the initial assessments in psychiatric and neurological practice. Performing electroencephalogram and treating such patients with mood stabilizers, which have antiepileptic properties, can change the course of the mental illness decisively.
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Affiliation(s)
- Babak Najand
- Senior Psychiatrist at Vian Clinic, Tehran, Iran, Diplomate and Certified Therapist from the Academy of Cognitive Behavior Therapy (A-CBT)1974
| | - Andrew Christensen
- Consultant Psychiatrist, Chair of the Faculty of Psychotherapy of 170472RANZCP, Queensland Branch, Australia
| | - Michael Martin
- Department of Psychiatry, 95050Belmont Private Hospital, Brisbane, QLd, Australia
| | - Mark Spelman
- Medical Director of Belmont Private Hospital, Department of Psychiatry, 95050Belmont Private Hospital, Brisbane, QLd, Australia
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Goel P, Singh G, Bansal V, Sharma S, Kumar P, Chaudhry R, Bansal N, Chaudhary A, Sharma S, Sander JW. Psychiatric comorbidities among people with epilepsy: A population-based assessment in disadvantaged communities. Epilepsy Behav 2022; 137:108965. [PMID: 36343531 DOI: 10.1016/j.yebeh.2022.108965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
UNLABELLED Psychiatric disorders are frequent among people with epilepsy but often under-recognized. The diagnosis and treatment of these disorders in low- and low-middle-income countries (LMICs) are challenging. METHODS This cross-sectional survey included people recruited during a community epilepsy screening program involving 59,509 individuals from poor communities in Ludhiana in Northwest India. Adults (age ≥18 years) with confirmed epilepsy on antiseizure medications were screened for depression and anxiety using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7) twice over two years of follow-up. They were later interviewed for symptoms using the Brief Psychiatric Rating Scale, which was then confirmed by assessments by an experienced psychiatrist. RESULTS Of the 240 people with confirmed epilepsy, 167 (70%) were adults, of whom, 116 (70%) eventually participated in the study. The NDDI-E with a cut-off of 15 identified depression in 14 (12%) of 116 people after one year of follow-up and 17 (15%) at two years. The GAD-7 using a cut-off of 6 identified 22 (19%) at one year and 32 (28%) with anxiety at two years. The area under the curves for NDDI-E was estimated as 0.62 (95%CI, 0.51-0.73; SE: 0.06; p = 0.04) and for GAD-7 as 0.62 (95%CI, 0.46-0.78; SE: 0.08; p = 0.12). Brief Psychiatric Rating Scale identified 63 (54%) people with psychiatric symptoms, for whom, a psychiatric diagnosis was confirmed in 60 (52%). A psychiatric diagnosis was associated with education below high school [Odds Ratio (OR): 2.59, 95%CI, 1.12-5.1; p = 0.03], later age of seizure onset (OR, 1.05, 95%CI: 1.0-1.10; p = 0.04), seizure frequency of at least one/year at enrolment (OR, 2.36, 95%CI: 1.0-5.58; p = 0.05) and the use of clobazam (OR, 5.09, 95%CI, 1.40-18.42; p = 0.01). CONCLUSION Depression and anxiety are common in people with epilepsy. Our findings underscore the low yields of screening instruments, NDDI-E and GAD-7, and comparatively better professionally-administered diagnostic assessments in resource-limited settings in LMICs. Moreover, previously established cut-offs do not apply to the community studied.
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Affiliation(s)
- Parveen Goel
- Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Gagandeep Singh
- Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Neurology, Dayanand Medical College, Ludhiana, India; UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Vasu Bansal
- Department of Medicine, Dayanand Medical College, Ludhiana, India
| | - Suman Sharma
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Pankaj Kumar
- Department of Psychiatry, Dayanand Medical College, Ludhiana, India
| | - Rupesh Chaudhry
- Department of Psychiatry, Dayanand Medical College, Ludhiana, India
| | - Namita Bansal
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Anurag Chaudhary
- Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India
| | - Sarit Sharma
- Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 61004, China.
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Li XL, Wang S, Tang CY, Ma HW, Cheng ZZ, Zhao M, Sun WJ, Wang XF, Wang MY, Li TF, Qi XL, Zhou J, Luan GM, Guan YG. Translocation of High Mobility Group Box 1 From the Nucleus to the Cytoplasm in Depressed Patients With Epilepsy. ASN Neuro 2022; 14:17590914221136662. [PMID: 36383501 PMCID: PMC9677174 DOI: 10.1177/17590914221136662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 08/05/2023] Open
Abstract
Depression is a common psychiatric comorbidity in patients with epilepsy, especially those with temporal lobe epilepsy (TLE). The aim of this study was to assess changes in high mobility group box protein 1 (HMGB1) expression in epileptic patients with and without comorbid depression. Sixty patients with drug-resistant TLE who underwent anterior temporal lobectomy were enrolled. Anterior hippocampal samples were collected after surgery and analyzed by immunofluorescence (n = 7/group). We also evaluated the expression of HMGB1 in TLE patients with hippocampal sclerosis and measured the level of plasma HMGB1 by enzyme-linked immunosorbent assay. The results showed that 28.3% of the patients (17/60) had comorbid depression. HMGB1 was ubiquitously expressed in all subregions of the anterior hippocampus. The ratio of HMGB1-immunoreactive neurons and astrocytes was significantly increased in both TLE patients with hippocampal sclerosis and TLE patients with comorbid depression compared to patients with TLE only. The ratio of cytoplasmic to nuclear HMGB1-positive neurons in the hippocampus was higher in depressed patients with TLE than in nondepressed patients, which suggested that more HMGB1 translocated from the nucleus to the cytoplasm in the depressed group. There was no significant difference in the plasma level of HMGB1 among patients with TLE alone, TLE with hippocampal sclerosis, and TLE with comorbid depression. The results of the study revealed that the translocation of HMGB1 from the nucleus to the cytoplasm in hippocampal neurons may play a previously unrecognized role in the initiation and amplification of epilepsy and comorbid depression. The direct targeting of neural HMGB1 is a promising approach for anti-inflammatory therapy.
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Affiliation(s)
- Xiao-Li Li
- Department of Neurology, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China
| | - Shu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chong-Yang Tang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Hao-Wei Ma
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zi-Zhang Cheng
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Meng Zhao
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Wei-Jin Sun
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiong-Fei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Meng-Yang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tian-Fu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Epilepsy, Beijing, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Xue-Ling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guo-Ming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Epilepsy, Beijing, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Yu-Guang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Epilepsy, Beijing, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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9
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Chang W, Liu J, Nie L, Pang X, Lv Z, Zheng J. The Degree Centrality and Functional Connectivity in Patients With Temporal Lobe Epilepsy Presenting as Ictal Panic: A Resting State fMRI Study. Front Neurol 2022; 13:822253. [PMID: 35837228 PMCID: PMC9274169 DOI: 10.3389/fneur.2022.822253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesIctal panic (IP) can be observed occasionally in patients with temporal lobe epilepsy (TLE). Such descriptions can be found in previous studies, but the mechanism is still not clear and often confused with panic attacks in patients with panic disorder (PD). We try to use imaging methods (resting-state functional magnetic resonance imaging, rs-fMRI) to study the mechanism of this psychiatric comorbidity in patients with TLE.MethodsForty right-onset TLE patients were observed, including 28 patients with TLE but without IP and 12 patients with TLEIP along with 30 gender-age matched healthy controls were included. We collected clinical/physiological/neuropsychological and rs-fMRI data. Degree centrality (DC) and functional connectivity (FC) were calculated. For the DC and FC values, analysis of covariance (ANCOVA) was used to find different areas and t-tests were used to compare differences between the TLEIP, TLE without IP, and healthy control(HC)groups. The relationship between brain abnormalities and patient characteristics was explored by correlation analyses.ResultsNo significant differences in gender and age were found among the three groups, and no significant differences in education level, Montreal Cognitive Assessment (MOCA), Hamilton Depressive Scale (HAMD), Hamilton Anxiety Scale (HAMA), and epilepsy duration (years) between the TLEIP and TLE without IP groups. In addition to fear, other symptoms were observed, including nausea, palpitations, rising epigastric sensation, and dyspnea. There was no correlation between the duration of IP and HAMA. Moreover, all IP durations were <2 min. Compared to the HCs and TLE without IP group, the DC value of the TLEIP group in the left middle temporal gyrus (LMTG) was significantly increased. Compared to the HCs, FC could be found between the LMTG and left inferior temporal gyrus (LITG) in the TLEIP group. In addition, there was FC between the LMTG and cerebellum in the TLEIP group. The difference in the magnitude of FC between the TLEIP vs. HC group was greater than the difference between the TLE vs. HC group.ConclusionsThis study describes brain abnormalities in patients with TLEIP. These results will help to preliminarily understand the mechanism of ictal panic and abnormal functional connection in patients with TLE, and further explore the neuroimaging mechanism of ictal panic in patients with TLE.
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Affiliation(s)
- Weiwei Chang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinping Liu
- Department of Neurology, The Guilin People's Hospital, Guilin, China
| | - Liluo Nie
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaomin Pang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zongxia Lv
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinou Zheng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Jinou Zheng
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10
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SAPAP3 regulates epileptic seizures involving GluN2A in post-synaptic densities. Cell Death Dis 2022; 13:437. [PMID: 35513389 PMCID: PMC9072407 DOI: 10.1038/s41419-022-04876-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022]
Abstract
Aberrantly synchronized neuronal discharges in the brain lead to epilepsy, a devastating neurological disease whose pathogenesis and mechanism are unclear. SAPAP3, a cytoskeletal protein expressed at high levels in the postsynaptic density (PSD) of excitatory synapses, has been well studied in the striatum, but the role of SAPAP3 in epilepsy remains elusive. In this study, we sought to investigate the molecular, cellular, electrophysiological and behavioral consequences of SAPAP3 perturbations in the mouse hippocampus. We identified a significant increase in the SAPAP3 levels in patients with temporal lobe epilepsy (TLE) and in mouse models of epilepsy. In addition, behavioral studies showed that the downregulation of SAPAP3 by shRNA decreased the seizure severity and that the overexpression of SAPAP3 by recombinant SAPAP3 yielded the opposite effect. Moreover, SAPAP3 affected action potentials (APs), miniature excitatory postsynaptic currents (mEPSCs) and N-methyl-D-aspartate receptor (NMDAR)-mediated currents in the CA1 region, which indicated that SAPAP3 plays an important role in excitatory synaptic transmission. Additionally, the levels of the GluN2A protein, which is involved in synaptic function, were perturbed in the hippocampal PSD, and this perturbation was accompanied by ultrastructural morphological changes. These results revealed a previously unknown function of SAPAP3 in epileptogenesis and showed that SAPAP3 may represent a novel target for the treatment of epilepsy.
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11
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A Novel Pathway Phenotype of Temporal Lobe Epilepsy and Comorbid Psychiatric Disorders: Results of Precision Nomothetic Medicine. Antioxidants (Basel) 2022; 11:antiox11050803. [PMID: 35624666 PMCID: PMC9137678 DOI: 10.3390/antiox11050803] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 02/01/2023] Open
Abstract
No precision medicine models of temporal lobe epilepsy (TLE) and associated mental comorbidities have been developed to date. This observational study aimed to develop a precision nomothetic, data-driven comorbid TLE model with endophenotype classes and pathway phenotypes that may have prognostic and therapeutical implications. We recruited forty healthy controls and 108 TLE patients for this research and assessed TLE and psychopathology (PP) features as well as oxidative stress (OSTOX, e.g., malondialdehyde or MDA, lipid hydroperoxides, and advanced oxidation protein products) and antioxidant (paraoxonase 1 or PON1 status, -SH groups, and total radical trapping potential or TRAP) biomarkers. A large part (57.2%) of the variance in a latent vector (LV) extracted from the above TLE and PP features was explained by these OSTOX and antioxidant biomarkers. The PON1 Q192R genetic variant showed indirect effects on this LV, which were completely mediated by PON1 activity and MDA. Factor analysis showed that a common core could be extracted from TLE, PP, OSTOX and antioxidant scores, indicating that these features are manifestations of a common underlying construct, i.e., a novel pathway phenotype of TLE. Based on the latter, we constructed a new phenotype class that is characterized by increased severity of TLE, PP and OSTOX features and lowered antioxidant defenses. A large part of the variance in episode frequency was explained by increased MDA, lowered antioxidant, and nitric oxide metabolite levels. In conclusion, (a) PP symptoms belong to the TLE phenome, and the signal increased severity; and (b) cumulative effects of aldehyde formation and lowered antioxidants determine epileptogenic kindling.
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12
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Chang W, Lv Z, Pang X, Nie L, Zheng J. The local neural markers of MRI in patients with temporal lobe epilepsy presenting ictal panic: A resting resting-state postictal fMRI study. Epilepsy Behav 2022; 129:108490. [PMID: 35180570 DOI: 10.1016/j.yebeh.2021.108490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Temporal lobe epilepsy (TLE) is one of the most common focal epilepsies. Some patients with TLE have ictal panic (IP), which is often confused with panic attack (PA) in panic disorder (PD). Previous studies have described temporal lobe epilepsy with ictal panic (TLEIP), but the specific mechanisms remain unclear. Here, we used resting-state functional magnetic resonance imaging (rs-fMRI) to investigate local brain abnormalities in patients with TLEIP and tried to find neural markers to explore the mechanism of IP in patients with TLE. METHODS A total of 40 patients with TLE, including 28 patients with TLE and 12 patients with TLEIP along with 30 age- and gender-matched healthy controls were included. We collected clinical/physiological/neuropsychological and rs-fMRI data. Fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and degree centrality (DC) were calculated. ANOVA was used to find different areas and t-tests used to compare differences among fALFF, ReHo, and DC. Correlation analyses explored the relationship between local brain abnormalities and patient characteristics. RESULTS No significant differences in age and gender were found among the three groups, nor were there differences in education level, Montreal Cognitive Assessment (MOCA) and Hamilton Anxiety Scale (HAMA) between the TLEIP and TLE groups. All the onset sites of patients with TLEIP were on the right. In addition to fear, other symptoms observed included nausea, palpitations, rising epigastric sensation, and dyspnea. There were no correlations between duration of IP and HAMA (p = 0.659). Moreover, all IP durations were <2 min and most <1 min. Compared to the HCs group, the ReHo value of the TLEIP group in the right middle frontal gyrus was significantly decreased (GRF correction, two-tailed, voxel level P < 0.005, cluster level P < 0.05). Compared to the HCs and TLE groups, the DC value of the TLEIP group in the left middle temporal gyrus (MTG) was significantly increased (GRF correction, two-tailed, voxel level P < 0.005, cluster level P < 0.05). No regions showed any significant fALFF difference between HCs and TLE groups (GRF correction, two-tailed, voxel level P < 0.005, cluster level P < 0.05). CONCLUSIONS This research describes local brain abnormalities in patients with TLE presenting as IP. These results will be preliminarily conducive to understand the seizure mechanism of IP in patients with TLE, find out the MRI neural markers, and to further explore the neurophysiological mechanisms of IP in patients with TLE.
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Affiliation(s)
- Weiwei Chang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People's Republic of China
| | - Zongxia Lv
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People's Republic of China
| | - Xiaomin Pang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People's Republic of China
| | - Liluo Nie
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People's Republic of China
| | - Jinou Zheng
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People's Republic of China.
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13
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Li J, Ledoux-Hutchinson L, Toffa DH. Prevalence of Bipolar Symptoms or Disorder in Epilepsy: A Systematic Review and Meta-Analysis. Neurology 2022; 98:e1913-e1922. [PMID: 35292556 DOI: 10.1212/wnl.0000000000200186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This systematic review with meta-analysis (PROSPERO: CRD42021249336) was performed to estimate the pooled lifetime prevalence of bipolar symptoms (BS) and bipolar disorder (BD) in people with epilepsy (PWE). METHODS A search was performed on June 5th, 2021, in four databases (MEDLINE/PubMed, Ovid EMBASE, Ovid APA PsycInfo, and Web of Science) for original research reporting on BS/BD in PWE, with no restriction on language or time of publication. Inclusion criteria were as follows: 1) original research, 2) cross-sectional study design component, 3) reported a lifetime prevalence of BS/BD or enough information to calculate an estimate, and 4) reported the method by which participants were deemed bipolar. Studies based on an exclusively pediatric population were excluded. To calculate pooled lifetime prevalence of BS/BD, two meta-analytic random-effects models were fitted, one for BS, and the other for BD. Risk of bias was assessed using a standardized appraisal tool for studies reporting prevalence. Certainty of evidence was evaluated using the GRADE approach. RESULTS A total of 750 records were screened, and 17 studies were included for analysis: seven provided prevalence estimates for only BS, eight for only BD, and two for both BS and BD. After outlier exclusion and subgroup analysis using screening method as a moderator, the pooled prevalence of BS in PWE was 12.3% [95% CI; 10.6-14.1%] (7,506 PWE). The pooled prevalence of BD in PWE was 4.5% [95% CI; 2.2-7.4%] (48,334 PWE). Considerable heterogeneity was present - more so for BD than for BS - and could be explained through differences in population demographics and study methodology. DISCUSSION This study's main limitation was regarding the certainty of evidence. Notwithstanding, our estimates of prevalence should prompt further research on BS/BD in PWE. Given the significant morbidity associated to BD, clinicians should carefully screen PWE for BS.
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Affiliation(s)
- Jimmy Li
- Neurology Division, University of Sherbrooke Health Centre (CHUS), Sherbrooke, QC, Canada.,University of Montreal Health Centre Research Centre (CRCHUM), Montreal, QC, Canada
| | | | - Dènahin Hinnoutondji Toffa
- University of Montreal Health Centre Research Centre (CRCHUM), Montreal, QC, Canada.,Neurology Division, University of Montreal Health Centre (CHUM), Montreal, QC, Canada
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14
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Shamsi A, DasGupta D, Alhumaydhi FA, Khan MS, Alsagaby SA, Al Abdulmonem W, Hassan MI, Yadav DK. Inhibition of MARK4 by serotonin is an attractive therapeutic approach to combat Alzheimer’s disease and neuroinflammation. RSC Med Chem 2022; 13:737-745. [PMID: 35814926 PMCID: PMC9215163 DOI: 10.1039/d2md00053a] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/16/2022] [Indexed: 11/21/2022] Open
Abstract
The mitogen-activated protein kinases (MAPKs) govern various cellular programs and crucial intermediate pathways in signaling. Microtubule affinity-regulating kinase 4 (MARK4) is a part of the kinase family recognized for actively...
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Affiliation(s)
- Anas Shamsi
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar New Delhi 110025 India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University United Arab Emirates
| | - Debarati DasGupta
- College of Pharmacy, University of Michigan 428 Church Street Ann Arbor Michigan 48109 USA
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University Buraydah Saudi Arabia
| | - Mohd Shahnawaz Khan
- Department of Biochemistry, College of Sciences, King Saud University Riyadh 11451 Saudi Arabia
| | - Suliman A Alsagaby
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University Majmaah 11932 Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University Buraydah Saudi Arabia
| | - Md Imtaiyaz Hassan
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar New Delhi 110025 India
| | - Dharmendra Kumar Yadav
- College of Pharmacy, Gachon University of Medicine and Science Hambakmoeiro, Yeonsu-gu Incheon 21924 South Korea
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15
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Ong SK, Husain SF, Wee HN, Ching J, Kovalik JP, Cheng MS, Schwarz H, Tang TB, Ho CS. Integration of the Cortical Haemodynamic Response Measured by Functional Near-Infrared Spectroscopy and Amino Acid Analysis to Aid in the Diagnosis of Major Depressive Disorder. Diagnostics (Basel) 2021; 11:diagnostics11111978. [PMID: 34829325 PMCID: PMC8617819 DOI: 10.3390/diagnostics11111978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Major depressive disorder (MDD) is a debilitating condition with a high disease burden and medical comorbidities. There are currently few to no validated biomarkers to guide the diagnosis and treatment of MDD. In the present study, we evaluated the differences between MDD patients and healthy controls (HCs) in terms of cortical haemodynamic responses during a verbal fluency test (VFT) using functional near-infrared spectroscopy (fNIRS) and serum amino acid profiles, and ascertained if these parameters were correlated with clinical characteristics. Methods: Twenty-five (25) patients with MDD and 25 age-, gender-, and ethnicity-matched HCs were recruited for the study. Real-time monitoring of the haemodynamic response during completion of a VFT was quantified using a 52-channel NIRS system. Serum samples were analysed and quantified by liquid chromatography-mass spectrometry for amino acid profiling. Receiver-operating characteristic (ROC) curves were used to classify potential candidate biomarkers. Results: The MDD patients had lower prefrontal and temporal activation during completion of the VFT than HCs. The MDD patients had lower mean concentrations of oxy-Hb in the left orbitofrontal cortex (OFC), and lower serum histidine levels. When the oxy-haemoglobin response was combined with the histidine concentration, the sensitivity and specificity of results improved significantly from 66.7% to 73.3% and from 65.0% to 90.0% respectively, as compared to results based only on the NIRS response. Conclusions: These findings demonstrate the use of combination biomarkers to aid in the diagnosis of MDD. This technique could be a useful approach to detect MDD with greater precision, but additional studies are required to validate the methodology.
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Affiliation(s)
- Samantha K. Ong
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore;
| | - Syeda F. Husain
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119276, Singapore;
| | - Hai Ning Wee
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Graduate Medical School, Singapore 169609, Singapore; (H.N.W.); (J.C.); (J.-P.K.)
| | - Jianhong Ching
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Graduate Medical School, Singapore 169609, Singapore; (H.N.W.); (J.C.); (J.-P.K.)
| | - Jean-Paul Kovalik
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Graduate Medical School, Singapore 169609, Singapore; (H.N.W.); (J.C.); (J.-P.K.)
| | - Man Si Cheng
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore; (M.S.C.); (H.S.)
| | - Herbert Schwarz
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore; (M.S.C.); (H.S.)
| | - Tong Boon Tang
- Centre for Intelligent Signal and Imaging Research (CISIR), University Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia;
| | - Cyrus S. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Correspondence: ; Tel.: +65-67795555
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16
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Zummo L, Vitale AM, Caruso Bavisotto C, De Curtis M, Garbelli R, Giallonardo AT, Di Bonaventura C, Fanella M, Conway de Macario E, Cappello F, Macario AJL, Marino Gammazza A. Molecular Chaperones and miRNAs in Epilepsy: Pathogenic Implications and Therapeutic Prospects. Int J Mol Sci 2021; 22:ijms22168601. [PMID: 34445306 PMCID: PMC8395327 DOI: 10.3390/ijms22168601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a pathologic condition with high prevalence and devastating consequences for the patient and its entourage. Means for accurate diagnosis of type, patient monitoring for predicting seizures and follow up, and efficacious treatment are desperately needed. To improve this adverse outcome, miRNAs and the chaperone system (CS) are promising targets to understand pathogenic mechanisms and for developing theranostics applications. miRNAs implicated in conditions known or suspected to favor seizures such as neuroinflammation, to promote epileptic tolerance and neuronal survival, to regulate seizures, and others showing variations in expression levels related to seizures are promising candidates as useful biomarkers for diagnosis and patient monitoring, and as targets for developing novel therapies. Components of the CS are also promising as biomarkers and as therapeutic targets, since they participate in epileptogenic pathways and in cytoprotective mechanisms in various epileptogenic brain areas, even if what they do and how is not yet clear. The data in this review should help in the identification of molecular targets among the discussed miRNAs and CS components for research aiming at understanding epileptogenic mechanisms and, subsequently, develop means for predicting/preventing seizures and treating the disease.
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Affiliation(s)
- Leila Zummo
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Department of Neurology and Stroke Unit, A.R.N.A.S. Ospedale Civico—Di Cristina Benfratelli, 90127 Palermo, Italy
| | - Alessandra Maria Vitale
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Celeste Caruso Bavisotto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Marco De Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (M.D.C.); (R.G.)
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (M.D.C.); (R.G.)
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Martina Fanella
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Everly Conway de Macario
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD 21202, USA;
| | - Francesco Cappello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Alberto J. L. Macario
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD 21202, USA;
| | - Antonella Marino Gammazza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Correspondence:
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17
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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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18
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Wu C, Ren C, Teng Z, Li S, Silva F, Wu H, Chen J. Cerebral glucose metabolism in bipolar disorder: A voxel-based meta-analysis of positron emission tomography studies. Brain Behav 2021; 11:e02117. [PMID: 33769704 PMCID: PMC8119802 DOI: 10.1002/brb3.2117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Previous positron emission tomography studies have reported the changes of cerebral glucose metabolism in bipolar disorder. However, the findings across studies remain controversial, containing differing results. METHODS A systematic literature search of the PubMed, Embase, Cochrane Library, and Web of Science databases was conducted. We conducted a voxel-wide meta-analysis of cerebral glucose metabolism studies, using the seed-based mapping approach, in patients with bipolar disorder (BD). RESULTS We identified 7 studies suitable for inclusion, which included a total of 126 individuals with BD and 160 healthy controls. The most consistent and robust findings were an increase in cerebral glucose metabolism in the right precentral gyrus and a decrease in the left superior temporal gyrus, left middle temporal gyrus, and cerebellum. Additionally, the sex distribution and illness duration had significant moderating effects on cerebral glucose metabolism alterations. CONCLUSIONS Cerebral glucose metabolism alterations in these brain regions are likely to reflect the disease-related functional abnormalities such as emotion and cognition. These findings contribute to a better understanding of the neurobiological underpinnings of bipolar disorder. LIMITATIONS This study was done at a study level and cannot be addressed at the patient level. Subgroup analysis of BD I and BD II is not possible due to limited literature data.
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Affiliation(s)
- Chujun Wu
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chutong Ren
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ziwei Teng
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sujuan Li
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Floyd Silva
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Haishan Wu
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Chen
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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Teixeira AL. Peri-Ictal and Para-Ictal Psychiatric Phenomena: A Relatively Common Yet Unrecognized Disorder. Curr Top Behav Neurosci 2021; 55:171-181. [PMID: 33728598 DOI: 10.1007/7854_2021_223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with epilepsy can experience different neuropsychiatric symptoms related (peri-ictal) or not (interictal) with seizures. Peri-ictal symptoms can precede (pre-ictal) or follow (post-ictal) the seizure, or even be the expression of the seizure activity (ictal). Neuropsychiatric symptoms, such as irritability and apathy, are among the most frequent pre-ictal manifestations. Ictal fear is reported by around 10% of patients with focal seizures, and sometimes can be difficult to differentiate from panic attacks. Post-ictal anxiety, mood and psychotic symptoms are also frequently reported by patients. Peri-ictal phenomena can occur as isolated symptom or as a cluster of symptoms, sometimes resembling a full-blown psychiatric syndrome. Actually, peri-ictal and interictal neuropsychiatric manifestations seem to be closely associated.
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Affiliation(s)
- Antonio Lucio Teixeira
- Instituto de Ensino e Pesquisa, Santa Casa BH, Belo Horizonte, Brazil. .,Neuropsychiatry Program, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, UTHealth Houston, Houston, TX, USA.
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20
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Sair A, Şair YB, Saracoğlu İ, Sevincok L, Akyol A. The relation of major depression, OCD, personality disorders and affective temperaments with Temporal lobe epilepsy. Epilepsy Res 2021; 171:106565. [PMID: 33535159 DOI: 10.1016/j.eplepsyres.2021.106565] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/22/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In patients with temporal lobe epilepsy (TLE), studies demonstrate frequent comorbidity with mood disorders, personality disorders (especially obsessive-compulsive disorder) and major depression, but there are conflicting findings. This study aimed to investigate psychiatric comorbidities and affective temperament among TLE patients and to explore the relationships between obsessive compulsive disorder, other personality disorders, major depression and affective temperament in order to clarify the mediator effect of TLE in these relationships. METHODS Thirty patients with TLE and 30 healthy volunteers were included. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II), Hamilton Anxiety (HAM-A) scale, Hamilton Depression (HAM-D) scale, Beck Suicidal Ideation Scale (BSSI) and Yale Brown Obsession Compulsion Scale (YBOCS) were applied and evaluated by a psychiatrist. Additionally, all individuals completed The Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A). RESULTS Patients with temporal lobe epilepsy had higher scores in TEMPS-A, HAM-A, HAM-D, YBOCS and BSSI. Major depression, obsessive compulsive disorder and dependent and antisocial personality disorders were prevalent in patients. With respect to affective temperaments, depressive, cyclothymic and anxious temperaments were associated with obsessive compulsive disorder comorbidity; whereas, depressive and anxious temperaments were found to be associated with major depression comorbidity in patients with TLE. Furthermore, cluster A and cluster C personality disorders were associated with affective temperaments in patients with TLE. Affective temperaments had no correlation with illness duration, seizure frequency, depression severity and suicidal thoughts, but obsessions and compulsions. Suicidal thoughts were associated with obsessions and compulsions. CONCLUSION Affective temperaments are core personality traits with biological background and they may provide a foundation for psychiatric disorders, especially mood disorders. Considering that TLE originates from abnormalities in brain circuitry, it may form a basis for psychiatric disorders. Therefore, psychiatric evaluation to determine comorbidities may be beneficial to increase the quality of life of patients with TLE.
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Affiliation(s)
- Ahmet Sair
- Neurology Depertment, Aydın Adnan Menderes University Medicine Faculty, Turkey.
| | - Yaşan Bilge Şair
- Psychiatry Depertment, Aydın Adnan Menderes University Medicine Faculty, Turkey.
| | - İrem Saracoğlu
- Residant at Psychiatry Department, Aydın Adnan Menderes University Medicine Faculty, Turkey.
| | - Levent Sevincok
- Psychiatry Depertment, Aydın Adnan Menderes University Medicine Faculty, Turkey.
| | - Ali Akyol
- Neurology Depertment, Aydın Adnan Menderes University Medicine Faculty, Turkey.
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21
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Lu E, Pyatka N, Burant CJ, Sajatovic M. Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy. J Clin Neurol 2021; 17:176-186. [PMID: 33835737 PMCID: PMC8053555 DOI: 10.3988/jcn.2021.17.2.176] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose Mental illness is disproportionately common in people with epilepsy (PWE). This systematic literature review identified original research articles that reported the prevalence of psychiatric comorbidities based upon clinical assessments in a sample of PWE and assessed the clinical features of the populations found in studies included in our review of mental health comorbidity. Methods The included articles were written in English and published from 2008 to 2018, and focused on adults aged ≥18 years who had psychiatric diagnoses determined in clinical assessments, such as those found in medical records, clinician psychiatric evaluations, structured diagnostic interviews, and mental health screening questionnaires specific for a psychiatric disorder. The primary outcome was the prevalence of psychiatric comorbidities as a percentage of the total sample of PWE. Additional data included the overall sample size, mean age, epilepsy type, study design, and method of diagnosis. A modified Newcastle Ottawa Scale was used to assess the quality of the studies. All 23 articles that were consistent with the inclusion criteria were related to observational studies. Results Mood disorders and anxiety disorders were the most common psychiatric comorbidities, with prevalence rates of 35.0% and 25.6%, respectively. Major depressive disorder was the most common mood disorder, with a prevalence of 24.2%. Post-traumatic stress disorder (PTSD) had the highest reported prevalence among anxiety disorders, at 14.2%, followed by general anxiety disorder at 11.1%. Other comorbidities included psychosis (5.7%), obsessivecompulsive disorder (3.8%), schizophrenia (1.7%), bipolar disorder (6.2%), and substance abuse (7.9%). The pooled prevalence of suicidality, as reported for two studies, was 9.3%. Temporal lobe epilepsy (TLE) was associated with higher levels of psychiatric comorbidity. Two (8.7%) of the 23 studies compared psychiatric comorbidities in TLE with that of extratemporal lobe epilepsy (ETLE), and one of these two studies found that depression was more common in TLE (53.8%) than in ETLE (25%). Regarding seizure types, partial seizures were associated with a higher prevalence of depression vs generalized seizures. Conclusions This systematic literature review of recent original research found a relatively high prevalence of mental health comorbidities in PWE. Mood and anxiety disorders are the most common comorbidities, while psychotic spectrum conditions such as schizophrenia and bipolar disorder are much rarer. The prevalence of comorbidity may vary with the epilepsy type and treatment responsiveness. These findings suggest that screening tools for depression and anxiety should be included as part of the training for epilepsy care, while resources for other relatively common conditions such as PTSD and substance abuse disorders should be readily available to neurology specialists who treat PWE.
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Affiliation(s)
- Elaine Lu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nataliya Pyatka
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher J Burant
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Louis Stokes Cleveland VAMC, Cleveland, OH, USA
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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22
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Avalos JC, Silva BA, Tevés Echazu MF, Rosso B, Besocke AG, Del Carmen Garcia M. Quality of life in patients with epilepsy or psychogenic nonepileptic seizures and the contribution of psychiatric comorbidities. Epilepsy Behav 2020; 112:107447. [PMID: 32947249 DOI: 10.1016/j.yebeh.2020.107447] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 11/29/2022]
Abstract
UNLABELLED Epilepsy is a common neurological disorder, and psychogenic nonepileptic seizures (PNES) is an important differential diagnosis. Psychiatric comorbidities are prevalent among people with epilepsy (PWE). Additionally, lower quality of life (QoL) in people with PNES compared with PWE was reported with higher rates of general psychiatric comorbidity. Although there are previous studies evaluating the QoL in patients with epilepsy, this study is unique and compelling because it represents a study comparing PNES and PWE on QoL, depression, and anxiety in a Spanish-speaking group of Argentine patients. The aim of this study was to analyze self-reported anxiety and depression in PWE and PNES and to establish the impact on QoL. METHODS This is a cross-sectional study; QoL was measured using the Quality of Life in Epilepsy Inventory (QOLIE-31). To study anxiety and depression, the Hospital Anxiety and Depression Scale (HADS) was administered. Clinical and complementary data were recorded. RESULTS Psychogenic nonepileptic seizures scored significantly higher in anxiety and depression and with lower levels of QoL compared with PWE. Anxiety and depression had a negative correlation with QoL. CONCLUSION Nonepileptic seizures have an even greater impact on QoL than epileptic seizures, and this could be influenced by psychiatric comorbidities. These findings corroborate what other studies in English-speaking nations that have found regarding the impact of psychopathology on QoL in those with PNES and further support the importance of assessing for psychiatric comorbidities to tailor treatment.
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Affiliation(s)
- Juan Carlos Avalos
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | | | - Maria F Tevés Echazu
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | - Bárbara Rosso
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | - Ana Gabriela Besocke
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
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23
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Kirabira J, Lam A, Ssuna B, Rukundo GZ. Psychiatric disorders among children and adolescents with active epilepsy in southwestern Uganda. PAMJ ONE HEALTH 2020; 3:9. [PMID: 34604861 PMCID: PMC8486297 DOI: 10.11604/pamj-oh.2020.3.9.25146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION the study aimed to determine the prevalence of emotional, behavioral, developmental and psychosis related disorders among children and adolescents with active epilepsy aged 5 to 18 years in southwestern Uganda. METHODS we conducted a cross sectional study at one big urban hospital, two rural health centers and one rural special needs school. The disorders were assessed using an adapted parent version of the Child and Adolescent Symptom Inventory-5 (CASI-5). RESULTS one hundred and sixty-one participants were assessed, and 93 (57.8%) had at least one psychiatric disorder. Developmental disorders were the most prevalent at 39.8% (95%CI 32.11 - 47.39), followed by emotional disorders, 30.4% (95%CI 23.25-37.62), behavioral disorders, 7.5% (95%CI 3.35-11.55) and psychosis related disorders, 6.2% (95%CI 2.44 - 9.98). Thirty-nine participants (24.2%) had at least two psychiatric disorders. Developmental disorders were associated with younger age (aOR=0.86, p=0.001) and having epilepsy-related physical injuries and deformities (aOR=2.36, p=0.036). Emotional disorders (aOR=1.13, p=0.007) and psychosis related disorders (aOR=1.44, p=0.007) were associated with increasing age, whereas a family history of epilepsy was protective (aOR=0.22, p=0.042). CONCLUSION psychiatric disorders were highly prevalent among children and adolescents with epilepsy in southwestern Uganda; highlighting the need to integrate screening and management of these disorders into routine epilepsy care.
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Affiliation(s)
- Joseph Kirabira
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
- Department of Mental Health, Gulu University, PO Box 166, Gulu, Uganda
- Department of Mental Health and Psychiatry, Kampala International University, Western Campus, PO Box 71, Bushenyi, Uganda
| | - Alice Lam
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bashir Ssuna
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences (MakCHS), Kampala, Uganda
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Citherlet D, Boucher O, Gravel V, Roy-Côté F, Bouthillier A, Nguyen DK. The effects of insular and mesiotemporal lesions on affective information processing: Preliminary evidence from patients with epilepsy surgery. Epilepsy Behav 2020; 111:107264. [PMID: 32640413 DOI: 10.1016/j.yebeh.2020.107264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022]
Abstract
Depressive symptoms and anxiety are common complaints in patients who have had epilepsy surgery. Recent studies have reported disturbances in emotional memory, facial and vocal emotion recognition, and affective learning after temporal lobe and/or insular resection for drug-resistant seizures, suggesting that these regions may be involved in emotional processes underlying psychological symptoms. The insula is a core component of the salience network and is thought to be involved in processing emotions such as disgust, and the role of mesial temporal lobe structures in affective processing is well established. However, to our knowledge, no study has yet investigated whether attentional processing of affective information is altered when these structures are resected as part of an epilepsy surgery. The present study examined the interference control capacity and attentional biases for emotional information in adult patients with epilepsy who underwent temporal lobe resections including the amygdala and hippocampus (n = 15) and/or partial or complete insular resections (n = 16). Patients were tested on an Emotional Stroop test and on a Dot-Probe task using fearful and disgusting pictures and were compared with a healthy control group (n = 30) matched for age, gender, and education. Repeated-measures analyses of variances revealed a significant effect of emotional words on color naming speed in the Emotional Stroop task among insular patients, which was not observed in the other groups. By contrast, the groups did not differ on Dot-Probe task performance. These preliminary findings suggest that insular damage may alter emotional interference control.
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Affiliation(s)
- Daphné Citherlet
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de neurosciences, Montreal, Canada
| | - Olivier Boucher
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de psychologie, Montreal, Canada; CHUM, Service de psychologie, Montreal, Quebec, Canada
| | - Victoria Gravel
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de psychologie, Montreal, Canada
| | - Frédérique Roy-Côté
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de psychologie, Montreal, Canada
| | | | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de neurosciences, Montreal, Canada; CHUM, Service de neurologie, Montreal, Quebec, Canada.
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25
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Wang Y, Hou D, Wu X, Qiu L, Chen H, Xin J, Yan Z, Sun M. An intensive education program for caregivers ameliorates anxiety, depression, and quality of life in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis who underwent cortico-amygdalohippocampectomy. Braz J Med Biol Res 2020; 53:e9000. [PMID: 32696820 PMCID: PMC7372948 DOI: 10.1590/1414-431x20209000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to investigate the effect of a caregiver intensive education
program (CIEP) on anxiety, depression, and quality of life (QOL) in patients
with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis
(TLE-MTS) who underwent cortico-amygdalohippocampectomy (CAH). Ninety patients
with drug-resistant TLE-MTS who underwent CAH and their caregivers were
recruited and randomly allocated to the CIEP group or control group as 1:1
ratio. Caregivers received the CIEP program or routine guidance/education
(control group). Anxiety/depression and QOL in patients at month (M)0, M1, M3,
and M6 were assessed by the Hospital Anxiety and Depression Scale (HADS) scale
and the QOL in Epilepsy Inventory-31 (QOLIE-31), respectively. Treatment
efficacy at M6 was assessed by Engel classification. The HADS-anxiety score at
M3 (P=0.049) and M6 (P=0.028), HADS-anxiety score change (M6-M0) (P=0.001),
percentage of anxiety patients at M6 (P=0.025), and anxiety severity at M6
(P=0.011) were all decreased in the CIEP group compared with the control group.
The HADS-depression score at M6 (P=0.033) and HADS-depression score change
(M6-M0) (P=0.022) were reduced, while percentage of depression patients at M6
(P=0.099) and depression severity at M6 (P=0.553) showed no difference in the
CIEP group compared with the control group. The QOLIE-31 score at M6 (P=0.043)
and QOLIE-31 score change (M6-M0) (P=0.010) were both elevated in the CIEP group
compared with the control group. In conclusion, CIEP for caregivers contributed
to the recovery of anxiety and depression as well as the improvement of QOL in
patients with drug-resistant TLE-MTS who underwent CAH.
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Affiliation(s)
- Yuena Wang
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongyu Hou
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaohua Wu
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lili Qiu
- Department of Endocrinology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Chen
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianxia Xin
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhirong Yan
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Meiling Sun
- Department of Nursing, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
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Maes M, Supasitthumrong T, Limotai C, Michelin AP, Matsumoto AK, de Oliveira Semão L, de Lima Pedrão JV, Moreira EG, Carvalho AF, Sirivichayakul S, Barbosa DS, Kanchanatawan B. Increased Oxidative Stress Toxicity and Lowered Antioxidant Defenses in Temporal Lobe Epilepsy and Mesial Temporal Sclerosis: Associations with Psychiatric Comorbidities. Mol Neurobiol 2020; 57:3334-3348. [PMID: 32514863 DOI: 10.1007/s12035-020-01949-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/22/2020] [Indexed: 01/26/2023]
Abstract
Oxidative stress toxicity (OSTOX), as well as lowered antioxidant defenses (ANTIOX), plays a role in temporal lobe epilepsy (TLE). Nevertheless, the associations between OSTOX/ANTIOX and psychiatric comorbidities in TLE are largely unknown. Thus, this study examines plasma malondialdehyde (MDA), lipid hydroperoxides (LOOH), advanced oxidation protein products (AOPP), nitric oxide metabolites (NOx), total radical-trapping antioxidant parameter (TRAP), and sulfhydryl (-SH) groups in depression due to TLE (n = 25); anxiety disorders due to TLE (n = 27); psychotic disorder due to TLE (n = 25); "pure TLE" (n = 27); and healthy controls (n = 40). TLE and mesial temporal sclerosis (MTS) were characterized by significant increases in OSTOX (MDA, AOPP, LOOH) and lowered ANTIOX (-SH groups, TRAP). The discrimination of pure TLE from controls yielded a significant area under the ROC curve for MDA (0.999), AOPP (0.851), -SH groups (0.899), and the OSTOX/ANTIOX ratio (0.996). Seizure frequency is significantly associated with increased MDA and lowered LOOH and NOx levels. Increased MDA was associated with the severity of depressive and physiosomatic symptoms, while increased AOPP levels predicted suicidal ideation. Depression and anxiety disorders co-occurring with TLE showed significantly lower MDA levels than TLE without any comorbidities. The psychotic and negative symptoms of TLE are associated with increased MDA levels and excitation with increased LOOH and lowered TRAP levels. These results indicate that oxidative stress toxicity especially protein oxidation and aldehyde formation coupled with lowered -SH groups plays a key role in the pathophysiology of TLE/MTS. Increased aldehyde formation also impacts psychopathology and psychosis, as well as negative and depressive symptoms.
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Affiliation(s)
- Michael Maes
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.,IMPACT Strategic Research Center, Deakin University, Geelong, Australia
| | - Thitiporn Supasitthumrong
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chusak Limotai
- Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC), The Thai Red Cross Society; Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ana Paula Michelin
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, PR, Brazil
| | - Andressa Keiko Matsumoto
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, PR, Brazil
| | - Laura de Oliveira Semão
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, PR, Brazil
| | - João Victor de Lima Pedrão
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, PR, Brazil
| | | | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | | | - Décio Sabbatini Barbosa
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, PR, Brazil
| | - Buranee Kanchanatawan
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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27
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McCartney L, Johnstone B, O'Brien T, Kwan P, Kalincik T, Velakoulis D, Malpas C. Psychometric properties of the Hospital Anxiety and Depression Scale in an inpatient video-monitoring epilepsy cohort. Epilepsy Behav 2020; 103:106631. [PMID: 31870806 DOI: 10.1016/j.yebeh.2019.106631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with epilepsy (PWE) have high rates of comorbid anxiety disorders and depressive disorders, from 25% in general population cohorts to rates of 55% in people with treatment resistant epilepsy. High rates are also seen in patients with psychogenic nonepileptic seizures (PNES). Depressive disorders and anxiety disorders in PWE are associated with decreased quality of life measures and are the strongest risk factors for increased suicidality, rates of which are markedly elevated in PWE, at 12%, compared to the general Australian population (1.8%). The Hospital Anxiety and Depression Scale (HADS) is one of the more commonly used screening tools in medical populations. Past studies of the HADS in general outpatient populations with epilepsy have demonstrated promising validity for detecting depression. OBJECTIVES The following were the objectives of the study: 1. To examine the validity of HADS in detecting depressive disorders and anxiety disorders in an inpatient population of patients admitted for video monitoring. 2. To investigate the measurement structure of the HADS across the diagnosis groups of epilepsy subtypes and PNES. METHODS This was a retrospective cohort study of 485 patients admitted to a tertiary epilepsy video electroencephalography (EEG) monitoring unit. All patients received clinical neurological, neuropsychiatric, and neuroimaging assessments to arrive at consensus epilepsy and psychiatric diagnoses. Clinical psychiatric diagnosis of depressive disorders and anxiety disorders, based on the assessment of a neuropsychiatrist, were compared to accepted HADS cutoff scores for these conditions. FINDINGS Of the 485 patients, 229 patients were with epilepsy, 28 had both epilepsy and PNES, and 121 had PNES. In 107 cases, no definite diagnosis could be made. At a cutoff score of 7 HADS was able to significantly classify patients with depression (area under the curve [AUC] = 0.79, 95% confidence interval [CI] = 0.72-0.82) with a sensitivity of 70% and a specificity of 83%. A similar result was observed for anxiety disorders; a cutoff score of 7 (AUC = 0.75, 95% CI = 0.72-0.81) was able to significantly classify anxiety disorders in patients with a sensitivity of 88% and specificity of 54%. CONCLUSIONS This study has found that HADS measures two separate, yet correlated, constructs of anxiety disorders and depressive disorders. Our results indicate that while the HADS is sensitive to distress in this population, relatively low cutoff scores would be required to achieve highly sensitive screening. This sample includes patients with a diagnosis of epilepsy and/or PNES, and thus, the findings have clinical applicability to screening in tertiary epilepsy video-EEG monitoring units where both these conditions frequently co-occur.
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Affiliation(s)
- Lara McCartney
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia.
| | - Benjamin Johnstone
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Terence O'Brien
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia
| | - Patrick Kwan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia
| | - Tomas Kalincik
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; CORe, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Dennis Velakoulis
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Charles Malpas
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia; CORe, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
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Kilicaslan EE, Türe HS, Kasal Mİ, Çavuş NN, Akyüz DA, Akhan G, Besiroglu L. Differences in obsessive-compulsive symptom dimensions between patients with epilepsy with obsessive-compulsive symptoms and patients with OCD. Epilepsy Behav 2020; 102:106640. [PMID: 31805512 DOI: 10.1016/j.yebeh.2019.106640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/28/2019] [Accepted: 09/28/2019] [Indexed: 01/24/2023]
Abstract
Clinical correlates of obsessive-compulsive symptoms (OCS) were evaluated in 100 adult consecutive outpatients with epilepsy, using the Obsessive-Compulsive Inventory (OCI-R), Beck Depression Inventory (BDI), Dissociative Experiences Scale (DES-II), and the Schizotypal Personality Questionnaire (SPQ). Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) was applied to determine the types and severity of OCS to the 45 patients with epilepsy who were over 21 points on the OCI-R scale and 30 patients who were with diagnosed obsessive-compulsive disorder (OCD) among the patients in the psychiatry outpatient clinic, as a control group. As a result, it was found that patients with epilepsy with OCS tend to have more symmetry/exactness obsessions and compulsions, whereas patients with OCD had significantly more contamination/cleaning and aggressiveness obsessions and compulsions. In addition, OCS was found to be significantly higher in temporal lobe epilepsy (TLE) and extratemporal epilepsy than generalized epilepsy. However, OCS were correlated with depression, dissociation, and schizotypy in patients with epilepsy, while only depression was predictive when regression analysis was performed for OCS. This study is the first study to compare patients with OCD with patients with epilepsy in terms of the nature of OCS and first identified the differences in OCS dimensions between patients with epilepsy with OCS and patients with OCD.
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Affiliation(s)
- Esin Evren Kilicaslan
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Basin Sitesi, 35150 Izmir, Turkey.
| | - H Sabiha Türe
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Neurology Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Meltem İzci Kasal
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Nebile Nur Çavuş
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Dilek Altın Akyüz
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Neurology Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Galip Akhan
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Neurology Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Lutfullah Besiroglu
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Basin Sitesi, 35150 Izmir, Turkey
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Comparison of psychiatric comorbidities and impact on quality of life in patients with epilepsy or psychogenic nonepileptic spells. Epilepsy Behav 2020; 102:106649. [PMID: 31759316 DOI: 10.1016/j.yebeh.2019.106649] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Psychiatric comorbidity is common in people with epilepsy (PWE) and psychogenic nonepileptic spells (PNES). These comorbidities can be detrimental to quality of life (QOL) and are often underdiagnosed and undertreated. Some types of epilepsy, such as focal temporal lobe epilepsy (TLE), have been associated with higher rates of psychiatric comorbidity. This study examined the impact of psychiatric comorbidity on QOL in patients admitted to two level 4 epilepsy monitoring units (EMUs). METHODS In this prospective observational study, 200 patients admitted to two level 4 EMUs completed standardized surveys including the Quality of Life in Epilepsy (QOLIE-31-P), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), and Beck Depression Inventory-II (BDI-II). Hierarchal multiple regression was performed to assess impact on QOL. RESULTS Of the 200 participants, 113 had a diagnosis of epilepsy, 36 had a diagnosis of PNES, and 51 were excluded for nondiagnostic evaluation or dual diagnosis. Of those with epilepsy, 65 had TLE, 28 had focal extratemporal lobe epilepsy (ETLE), and 20 had nonfocal epilepsy. Patients with PNES had higher self-reported anxiety and depression levels (GAD-7: p = 0.04, PHQ-9: p < 0.01; BDI-II: p < 0.01) but similar QOL to PWE (p = 0.78). Using hierarchal multiple regression, symptoms of anxiety and depression were significant predictors of lower QOL in PWE but not in patients with PNES. There was no difference in QOL in those with ETLE and TLE. CONCLUSIONS Our findings suggest that self-reported anxiety and depression symptoms are common in patients admitted to level 4 EMUs regardless of diagnosis and play an important role in predicting QOL in PWE. Our findings emphasize the importance of routinely screening all EMU patients for psychiatric comorbidity.
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Factors associated with obsessive-compulsive symptoms in people with epilepsy. Epilepsy Behav 2020; 102:106723. [PMID: 31805509 DOI: 10.1016/j.yebeh.2019.106723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Obsessive-compulsive disorder (OCD) is a common but underrecognized psychiatric condition comorbid with epilepsy. We thus investigated clinical factors associated with obsessive-compulsive symptoms (OCS) in adults with epilepsy. METHODS This was a cross-sectional multicenter study in Republic of Korea. Obsessive-compulsive symptoms were assessed using the Obsessive-Compulsive Inventory-Revised (OCI-R). Clinical factors that were assessed included age, sex, seizure-related variables, and the number and use of antiepileptic drugs (AEDs) prescribed. Data were analyzed by stepwise linear regression and adjusted according to anxiety and depressive symptoms as assessed by Hospital Anxiety Depression Scale (HADS). RESULTS The study population comprised 221 adults with epilepsy (42.1% male, 39.7 ± 11.9 years of age). The mean OCI-R score was 18.0 (standard deviation, 12.7), and an OCI-R score of ≥21 was obtained for 40.3% of the study sample. On a stepwise linear regression analysis, epilepsy severity, temporal lobe seizures, the use of topiramate, and the use of lamotrigine were identified as independent factors associated with OCI-R score after adjusting for anxiety according to the HADS. All factors except topiramate usage were positively associated with OCS. The total explained variance was 37.3%. CONCLUSIONS Obsessive-compulsive symptoms are common in persons with epilepsy and are associated with severe epilepsy, temporal lobe seizures, and the use of topiramate and lamotrigine. Specifically, the use of lamotrigine may aggravate OCS, whereas the use of topiramate may have beneficial effects on OCS.
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Wubie MB, Alebachew MN, Yigzaw AB. Common mental disorders and its determinants among epileptic patients at an outpatient epileptic clinic in Felegehiwot Referral Hospital, Bahirdar, Ethiopia: cross-sectional study. Int J Ment Health Syst 2019; 13:76. [PMID: 31890001 PMCID: PMC6935222 DOI: 10.1186/s13033-019-0333-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/18/2019] [Indexed: 12/05/2022] Open
Abstract
Background Epilepsy is a chronic neurological condition that is highly predisposed to a variety of mental health problems due to its huge biological, social and psychological burdens. Despite this, there is a paucity of research in this area. Therefore, assessing common mental disorders and its determinants among epileptic patients would be of great importance. Objective This study was aimed to asses prevalence and associated factors of common mental disorders among people with epilepsy attending Felegehiwot Referral Hospital, Bahirdar, Ethiopia, 2019. Methods Institutional based analytic cross-sectional study design was utilized from January to February 2019 at Felegehiwot Referral Hospital among 422 epileptic patients who were diagnosed clinically and on follow up treatment. Systematic random sampling was applied to recruit participants. Interviewer based and pretested Self Reporting Questionnaire‐20 was used to screen common mental illness with a cut-off point 7 and above as having a common mental disorder. Bivariate and multivariable logistic regression analysis with 95% CI were computed and variables with p < 0.05 in the final model were considered as associated factors for common mental disorders. Result Four hundred twenty-two patients with epilepsy were included in our study with a response rate of 100% and 64.5% were males. The mean age of participants was 59 ± 13.37 years. Common mental disorder among epileptic patients was found to be 35.8%. There was a statistically significant association between marital status, comorbid medical illness, nicotine dependence, alcohol misuse, and medication non-adherence with common mental disorders at p < 0.05. Conclusion The prevalence of common mental distress was high (35.8%) suggesting that it is a public health issue. Marital status, comorbid medical illness, nicotine dependence, alcohol misuse, and medication non-adherence were the factors having an association with a common mental disorder. Therefore, early screening and recognition of mental distress symptoms should be a routine activity while managing epileptic patients.
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Affiliation(s)
- Mengesha Birkie Wubie
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho Alebachew
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asmare Belete Yigzaw
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Lin CY, Lim SN, Chiangn HI, Cheng MY, Chang CW, Tseng WEJ, Hsieh HY, Li HT, Wu T. Effectiveness and safety of perampanel in adults with mesial temporal epilepsy: A single-center postmarketing study in Taiwan. Medicine (Baltimore) 2019; 98:e17171. [PMID: 31626082 PMCID: PMC6824632 DOI: 10.1097/md.0000000000017171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Mesial temporal lobe epilepsy (MTLE) is a common epilepsy syndrome often refractory to antiepileptic drug (AED) treatment. The purpose of this study was to evaluate the effectiveness and tolerability of perampanel (PER) as add-on treatment for patients of MTLE.We pooled retrospective data from adult patients with MTLE, from a tertiary center in Taiwan, who were prescribed PER between March 2016 and December 2016. The retention, responder, and seizure-free rate as well as the treatment emergent adverse events were assessed after 6 months of PER adjunctive treatment in this single-center postmarketing study.Review of medical records revealed that adequate data were available for 44 patients who were being administered PER (mean age: 42.0 ± 13.3 years, 24 females; baseline mean seizure frequency: 5.4 per 28 days). Twelve patients exhibited hippocampal sclerosis (HS). Open-label PER was added to ongoing medications. Twelve patients withdrew because of ineffectiveness (n = 6) or adverse effects (n = 6). The retention rate was 72.7% at 6 months. On final evaluation, with a mean PER dose of 5.7 mg/day for 6 months, a ≥50% reduction in seizure frequency was observed in 46.9% of the patients, and 5 patients became seizure-free. The effectiveness was similar for patients with or without HS. Twenty-three patients (52.3%) experienced adverse effects. The most common adverse effects were dizziness, ataxia, and irritability.Our results suggest that PER, at doses of 2 to 12 mg/day, reduces seizure frequency effectively with acceptable safety profiles for adults with MTLE.
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Machado RA, Benjumea-Cuartas V, Zapata Berruecos JF, Agudelo-Flóres PM, Salazar-Peláez LM. Reelin, tau phosphorylation and psychiatric complications in patients with hippocampal sclerosis and structural abnormalities in temporal lobe epilepsy. Epilepsy Behav 2019; 96:192-199. [PMID: 31150999 DOI: 10.1016/j.yebeh.2019.04.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/17/2019] [Accepted: 04/27/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Temporal lobe epilepsy (TLE) is the most common adult epileptic syndrome. About 30-70% of those cases have neuropsychiatric complications. More than 10% of patients have TLE because of focal cortical dysplasia (FCD) type IIIa. OBJECTIVES The objective of this study was to review the evidence of reelin (RELN) deficiency and tau phosphorylation role in the histopathological, neuropsychiatric, and hyperexcitability features in TLE because of dysplasia type IIIa. METHODS The current literature was reviewed using Cochrane, EMBASE, PROSPERO, MEDLINE, and PubMed from 1995 to July 2018. Articles of interest were reviewed by one investigator (RAM). RESULTS Reelin deficit is related to an abnormal migration of neurons in dentate gyrus, and its deficit causes dentate gyrus abnormalities, which in turn has been associated with memory deficits in patients with TLE. A decreased in the expression of RELN ribonucleic acid (RNA) was found in patients with TLE and dysplasia type IIIa compared with patients with TLE and isolated hippocampal sclerosis (HS). Reelin might affect the distribution and dynamic instability of microtubules within neurons in the cerebral cortex and their phosphorylation. Amyloid pathology, tauopathy, or phosphorylated tau (p-tau) overexpression has been reported in epileptic human brain and in animal models of epilepsy. CONCLUSION Reelin deficit may determine an abnormal cortical lamination and dentate gyrus dispersion and might be associated with an abnormal tau phosphorylation. These processes can be associated with an abnormal hyperexcitability, neuropsychiatric complications, and a myriad of typical histopathological features seen in patients with TLE because of dysplasia type IIIa.
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Affiliation(s)
| | - Vanesa Benjumea-Cuartas
- Neurologist-epileptologist at Neurology Institute of Colombia. Grupo de Investigación en Ciencias Básicas, Escuela de Graduados, Universidad CES
| | - José Fernando Zapata Berruecos
- Neurology at Neurology Institute of Colombia, Grupo de Investigación en Ciencias Básicas, Escuela de Graduados, Universidad CES
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Budikayanti A, Larasari A, Malik K, Syeban Z, Indrawati LA, Octaviana F. Screening of Generalized Anxiety Disorder in Patients with Epilepsy: Using a Valid and Reliable Indonesian Version of Generalized Anxiety Disorder-7 (GAD-7). Neurol Res Int 2019; 2019:5902610. [PMID: 31275648 PMCID: PMC6582805 DOI: 10.1155/2019/5902610] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/17/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is one of the most common types of anxiety disorder in epilepsy population, comprising 21.9%, that would further impair patients' quality of life. Generalized Anxiety Disorder-7 (GAD-7) is the only screening tool for GAD that has been validated in patients with epilepsy (PWE). It is a self-reporting instrument that can be completed in less than three minutes; hence, its usage is appropriate in primary healthcare and neurology outpatient clinic. This study aimed to obtain a valid and reliable Indonesian version of GAD-7, assess its accuracy, and finally evaluate the prevalence of GAD in Indonesian PWE along with its contributing factors. METHODS A cross-sectional study was conducted in Cipto Mangunkusumo General Hospital, Jakarta. The GAD-7 was translated and adapted using World Health Organization (WHO) steps. Validity, reliability, test-retest reliability, and diagnostic accuracy were evaluated. Then, epilepsy outpatients were screened for GAD using the Indonesian version of GAD-7. RESULTS Internal validity and reliability for Indonesian version of GAD-7 were satisfactory with validity coefficient of 0.648 to 0.800 (p<0.01) and Cronbach's alpha value of 0.867. The best cutoff value to detect GAD in Indonesian PWE was >6 with the sensitivity, specificity, negative predictive value, and positive predictive value of 100%, 84.4%, 100%, and 55.8%, respectively. ROC analysis showed the area under the curve of 0.98 (95% CI: 0.96-0.99). The total subjects screened with the validated Indonesian version of GAD-7 were 146, and 49% were screened as having GAD. Sociodemographic and clinical characteristics had no statistically significant association with the presence of GAD. CONCLUSION The Indonesian version of GAD-7 was a valuable screening tool to detect GAD in PWE. GAD was screened in a quite high proportion of PWE. Sociodemographic and clinical characteristics were not proven to play role in its development.
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Affiliation(s)
- Astri Budikayanti
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Andira Larasari
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Khamelia Malik
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Zakiah Syeban
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Luh Ari Indrawati
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fitri Octaviana
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Snoeijen‐Schouwenaars FM, van Ool JS, Tan IY, Aldenkamp AP, Schelhaas HJ, Hendriksen JGM. Mood, anxiety, and perceived quality of life in adults with epilepsy and intellectual disability. Acta Neurol Scand 2019; 139:519-525. [PMID: 30820944 DOI: 10.1111/ane.13085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Depression and anxiety symptoms are common among patients with epilepsy, but are relatively under-researched in patients with both epilepsy and intellectual disability (ID). The aim was to investigate whether epilepsy and ID characteristics are associated with mood, anxiety, and quality of life. MATERIALS AND METHODS Adult patients with epilepsy and ID who rely on tertiary epilepsy care were included (N = 189). Mood, anxiety, and quality of life were assessed by standardized questionnaires. Epilepsy and ID characteristics were retrieved from patient charts or determined by psychometric instruments. RESULTS Elevated levels of depressive and anxiety symptoms were present in 21.7% and 12.7%, respectively. Anxiety was significantly associated with a focal epilepsy type and ID domain discrepancy (substantial difference between two domains of adaptive behavior), but was negatively related to seizure frequency and drug load of mood-stabilizing antiepileptic drugs. Depressive symptoms were not significantly related to epilepsy characteristics, but a severe ID and ID domain discrepancy was associated with more depressive symptoms. Quality of life was significantly worse in those with multiple seizure types and ID domain discrepancy. CONCLUSION Whereas anxiety and quality of life are associated with individual epilepsy characteristics, this could not be confirmed for depressive symptoms in patients with epilepsy and ID, despite its high prevalence.
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Affiliation(s)
| | - Jans S. van Ool
- Department of Residential Care Kempenhaeghe Epilepsy Center Heeze The Netherlands
| | - In Y. Tan
- Department of Residential Care Kempenhaeghe Epilepsy Center Heeze The Netherlands
| | - Albert P. Aldenkamp
- Department of Behavioral Sciences Kempenhaeghe Epilepsy Center Heeze The Netherlands
- Department of Neurology Maastricht University Medical Center Maastricht The Netherlands
- Department of Neurology Ghent University Hospital Ghent Belgium
- Department of Electrical Engineering University of Technology Eindhoven The Netherlands
| | - Helenius J. Schelhaas
- Department of Neurology Academic Center for Epileptology Kempenhaeghe Heeze The Netherlands
| | - Jos G. M. Hendriksen
- Department of Behavioral Sciences Kempenhaeghe Epilepsy Center Heeze The Netherlands
- Department of Neurology Maastricht University Medical Center Maastricht The Netherlands
- Center of Neurological Learning Disabilities Kempenhaeghe Heeze The Netherlands
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Jansen C, Francomme L, Vignal JP, Jacquot C, Schwan R, Tyvaert L, Maillard L, Hingray C. Interictal psychiatric comorbidities of drug-resistant focal epilepsy: Prevalence and influence of the localization of the epilepsy. Epilepsy Behav 2019; 94:288-296. [PMID: 30429057 DOI: 10.1016/j.yebeh.2018.06.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 11/27/2022]
Abstract
Psychiatric comorbidities are 2 to 3 times more frequent in patients with epilepsy than in the general population. This study aimed to prospectively assess the following: (i) the prevalence of specific and nonspecific interictal psychiatric comorbidities in a population of patients with drug-resistant focal epilepsy and (ii) the influence of epilepsy lateralization and localization on these psychiatric comorbidities. In this prospective monocentric study, we collected demographic data, characteristics of the epilepsy, interictal psychiatric comorbidities, mood, anxiety, and alexithymia dimensions. We used criteria from Diagnostic and Statistical Manual of Mental Disorders IV ( DSM IV) (Mini International Mental Interview (MINI)), diagnosis criteria for specific comorbidities, and validated mood and anxiety scales (general and specific for epilepsy). Among the 87 enrolled patients (39 males, 48 females), 52.9% had at least one psychiatric comorbidity. The most common comorbidity was anxiety disorder (28.7% according to the MINI, and 38.4% screening by the Generalized Anxiety Disorder 7 (GAD 7)). Mood disorders were the second most frequent psychiatric comorbidity: 21.8% of our patients had interictal dysphoric disorders (IDDs), 16.1% presented major depressive disorders according to the MINI, and 17.2% screening by the Neurological Disorders Depression Inventory for Epilepsy (NDDIE). Patients with temporal lobe epilepsy had a higher prevalence of psychiatric comorbidities than patients with extratemporal lobe epilepsy (p = 0.002), which is probably related to a higher rate of anxiety disorders in this subgroup (p = 0.012). Prevalence of psychiatric disorders prior to epilepsy in patients was higher in right- than in left-sided epilepsy (p = 0.042). No difference was found according to limbic involvement at seizure onset. Overall, this article highlighted a very high proportion of anxiety disorders in these patients with drug-resistant focal epilepsy and the necessity to systematically detect them and thus lead to a specific treatment.
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Affiliation(s)
- Claire Jansen
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, F-54521 Laxou, France; Université de Lorraine, Faculté de Médecine, Vandoeuvre-lès-Nancy, France; Institut National de la Santé et de la Recherche Médicale U1114, Université de Strasbourg, Strasbourg, France
| | - Léa Francomme
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, F-54521 Laxou, France; Université de Lorraine, Faculté de Médecine, Vandoeuvre-lès-Nancy, France
| | - Jean-Pierre Vignal
- Université de Nancy CNRS, CRAN, UMR 7039, FR 54516, France; Centre Hospitalier Universitaire de Nancy, Département de Neurologie, Nancy FR 54000, France
| | - Caroline Jacquot
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, F-54521 Laxou, France; Université de Lorraine, Faculté de Médecine, Vandoeuvre-lès-Nancy, France
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, F-54521 Laxou, France; Université de Lorraine, Faculté de Médecine, Vandoeuvre-lès-Nancy, France; Institut National de la Santé et de la Recherche Médicale U1114, Université de Strasbourg, Strasbourg, France
| | - Louise Tyvaert
- Université de Lorraine, Faculté de Médecine, Vandoeuvre-lès-Nancy, France; Université de Nancy CNRS, CRAN, UMR 7039, FR 54516, France; Centre Hospitalier Universitaire de Nancy, Département de Neurologie, Nancy FR 54000, France
| | - Louis Maillard
- Université de Lorraine, Faculté de Médecine, Vandoeuvre-lès-Nancy, France; Université de Nancy CNRS, CRAN, UMR 7039, FR 54516, France; Centre Hospitalier Universitaire de Nancy, Département de Neurologie, Nancy FR 54000, France
| | - Coraline Hingray
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, F-54521 Laxou, France; Centre Hospitalier Universitaire de Nancy, Département de Neurologie, Nancy FR 54000, France.
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Wiglusz MS, Landowski J, Cubała WJ. Psychometric properties of the Polish version of the Hamilton Anxiety Rating Scale in patients with epilepsy with and without comorbid anxiety disorder. Epilepsy Behav 2019; 94:9-13. [PMID: 30884410 DOI: 10.1016/j.yebeh.2019.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/16/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Anxiety disorders (ADs) are frequent comorbid disorder in patients with epilepsy (PWE). The availability of validated screening instruments to detect AD in PWE is limited. The aim of the present study was to validate the Polish version of the Hamilton Anxiety Rating Scale (HARS) in adult PWE for the detection of AD. METHODS A total of 96 outpatient PWE completed the self-report symptom scale, the HARS, and were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HARS. RESULTS Receiver operating characteristic analyses showed areas under the curve at 81.2%. For diagnoses of AD, the HARS demonstrated the best psychometric properties for a cutoff score ≥17 with sensitivity of 68.8%, specificity of 87.5%, positive predictive value of 52.4%, and negative predictive value of 93.3%. CONCLUSIONS The Polish version of the HARS performed moderately well as a screening instrument for ADs in PWE. In the epilepsy setting, the HARS maintains moderate sensitivity, high specificity, and excellent Negative perdictive value (NPV) but low Positive perdictive value (PPV) for diagnosing ADs with an optimum cutoff score ≥17. These results suggest that the HARS performed better to rule out anxiety, however, because of moderate sensitivity, some cases of anxiety might be missed.
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Affiliation(s)
| | - Jerzy Landowski
- Department of Psychiatry, Medical University of Gdańsk, Poland
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Li Q, Chen D, Zhu LN, Wang HJ, Xu D, Tan G, Zhang Y, Liu L. Depression in people with epilepsy in West China: Status, risk factors and treatment gap. Seizure 2019; 66:86-92. [DOI: 10.1016/j.seizure.2019.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 12/18/2022] Open
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Toscano ECDB, Lessa JMK, Gonçalves AP, Rocha NP, Giannetti AV, de Oliveira GN, Rachid MA, Vieira ÉLM, Teixeira AL. Circulating levels of adipokines are altered in patients with temporal lobe epilepsy. Epilepsy Behav 2019; 90:137-141. [PMID: 30530136 DOI: 10.1016/j.yebeh.2018.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/08/2018] [Accepted: 11/21/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE A persistent low-grade inflammatory state has been described in patients with temporal lobe epilepsy (TLE) in the interictal period. Adipokines are cytokines produced by the adipose tissue that can influence inflammatory response. The purpose of this study was to evaluate the plasma levels of adipokines in patients with TLE in comparison with controls. In addition, we sought to investigate whether the levels of adipokines were associated with clinical parameters in TLE. METHODS Forty patients with TLE and 40 controls were enrolled in this study. All participants were subjected to clinical assessment that included the Mini International Neuropsychiatric Interview (MINI) and the Hamilton Depression Rating Scale (HAM-D). Peripheral blood was drawn, and plasma levels of adipokines (adiponectin, leptin, and resistin) were measured by enzyme-linked immunoassay (ELISA). RESULTS People with TLE presented higher leptin and lower adiponectin and resistin levels in comparison with controls. The levels of these adipokines correlated negatively with illness length but not with other clinical parameters. In a binary logistic regression model, higher leptin and lower adiponectin levels remained as significant predictors of TLE diagnosis. CONCLUSIONS These results corroborate the view that TLE is a multisystemic condition associated with low-grade inflammation.
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Affiliation(s)
- Eliana Cristina de Brito Toscano
- Laboratório Interdisciplinar de Investigação Médica, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - João Marcelo Korcsik Lessa
- Laboratório Interdisciplinar de Investigação Médica, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Paula Gonçalves
- Laboratório Interdisciplinar de Investigação Médica, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Natalia Pessoa Rocha
- Laboratório Interdisciplinar de Investigação Médica, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Texas Health Science Center at Houston, TX, United States
| | | | | | - Milene Alvarenga Rachid
- Laboratory of Cellular and Molecular Pathology, Department of Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Érica Leandro Marciano Vieira
- Laboratório Interdisciplinar de Investigação Médica, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Antônio Lúcio Teixeira
- Laboratório Interdisciplinar de Investigação Médica, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Texas Health Science Center at Houston, TX, United States
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Shen SQ, Sinha N, Perrin RJ, Ghoshal N, Hawasli AH, Womer FY. Acquired mania associated with a left temporal meningioma. Bipolar Disord 2018; 20:774-777. [PMID: 30447044 DOI: 10.1111/bdi.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Susan Q Shen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Namita Sinha
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Richard J Perrin
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Nupur Ghoshal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Ammar H Hawasli
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Fay Y Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Johnson AL, McLeish AC, Shear PK, Privitera M. Panic and epilepsy in adults: A systematic review. Epilepsy Behav 2018; 85:115-119. [PMID: 29940374 DOI: 10.1016/j.yebeh.2018.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/21/2018] [Accepted: 06/01/2018] [Indexed: 12/14/2022]
Abstract
The purpose of the current paper was to review the empirical literature on the cooccurrence of panic and epilepsy, in order to determine whether there is an increased risk of panic attacks and panic disorder among adults with epilepsy and an increased risk of epilepsy among adults with panic disorder. Given the overlap between panic and ictal fear, a preliminary aim of the current review was to critically evaluate the methodology used to differentiate between diagnoses of panic disorder and epilepsy in existing research. A literature search was conducted in relevant electronic databases, and articles that directly focused on panic and epilepsy among adults were selected for the current review (n = 17). Overall, results suggest that rates of epilepsy are elevated among individuals with panic disorder and that panic attacks are elevated among individuals with epilepsy, but rates of panic disorder among people with epilepsy are inconsistent. However, most studies did not use sufficiently rigorous methods to differentiate between panic disorder and epilepsy. Therefore, a critical next step in this area of research is to develop a standard procedure for differentiating ictal fear from panic attacks and panic disorder.
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Affiliation(s)
- Adrienne L Johnson
- Department of Psychology, University of Cincinnati, PO Box 210376, Cincinnati, OH 45221-0376, USA.
| | - Alison C McLeish
- Department of Psychology, University of Cincinnati, PO Box 210376, Cincinnati, OH 45221-0376, USA; Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA
| | - Paula K Shear
- Department of Psychology, University of Cincinnati, PO Box 210376, Cincinnati, OH 45221-0376, USA; Department of Neurology, Gardner Neuroscience Institute, University of Cincinnati, 260 Stetson St., Suite 2300, Cincinnati, OH 45267-0525, USA
| | - Michael Privitera
- Department of Neurology, Gardner Neuroscience Institute, University of Cincinnati, 260 Stetson St., Suite 2300, Cincinnati, OH 45267-0525, USA
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Demin K, Berger J, Holtkamp M, Bengner T. Are mental distress and cognitive impairment related in temporal lobe epilepsy? Epilepsy Res 2018; 146:126-131. [PMID: 30142462 DOI: 10.1016/j.eplepsyres.2018.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/14/2018] [Accepted: 07/27/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cognitive impairment and depression often co-exist among patients with epilepsy. However, there is still debate whether depression and cognition are related in patients with temporal lobe epilepsy (TLE). Even if they were related, it is still unclear whether symptoms of depression specifically, or rather symptoms of mental distress in general, have a negative impact on cognition in patients with TLE. In the present study, we examined whether self-rated symptoms of mental distress and of depression are related to different cognitive functions in unilateral TLE. METHODS We retrospectively studied 162 patients undergoing preoperative evaluation for epilepsy surgery (95 patients with left TLE (LTLE) and 67 patients with right TLE (RTLE)). Severity of mental distress and symptoms of depression were measured with the Symptom Checklist-90-Revised (SCL-90-R) and the Beck Depression Inventory (BDI), respectively. Bivariate correlations were calculated between these two measures and neuropsychological measures of verbal recall, figural learning, psychomotor speed, and phonemic word fluency. Due to multiple testing, a corrected level of p < 0.0063 was regarded as significant, only. RESULTS Seventeen and 19% of patients reported meaningful mental distress and meaningful symptoms of depression, respectively. Mental distress highly correlated with symptoms of depression (rs = 0.80). We found no significant correlations of either mental distress or symptoms of depression with measures of cognitive function. CONCLUSIONS In contrast to some former studies with smaller sample sizes, the present study could not detect a relationship of depression with cognitive impairment in patients with unilateral TLE. Likewise, mental distress and cognition were unrelated in our sample of patients. Our results may argue against theoretical models claiming a causal link between depression and cognitive impairment or a common pathogenic mechanism for these conditions in patients with TLE.
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Affiliation(s)
- Katharina Demin
- Epilepsy-Center Berlin-Brandenburg, Department of Epileptology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Epileptology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin, Berlin, Germany.
| | - Thomas Bengner
- Epilepsy-Center Berlin-Brandenburg, Department of Epileptology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
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Mehrabi S, Janahamdi M, Joghataie MT, Barati M, Marzban M, Hadjighassem M, Farahmandfar M. Blockade of p75 Neurotrophin Receptor Reverses Irritability and Anxiety-Related Behaviors in a Rat Model of Status Epilepticus. IRANIAN BIOMEDICAL JOURNAL 2018; 22:264-74. [PMID: 29108398 PMCID: PMC5949129 DOI: 10.22034/ibj.22.4.264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Abstract
Background Many recent epidemiological studies have shown that epileptic patients are more likely suffer from depression, anxiety, and irritability. However, the cellular mechanisms of epilepsy-induced psychotic behaviors are not fully elucidated. Neurotrophin receptors have been suggested to be involved in epilepsy and also in psychiatric disorders. Up-regulation of p75NTR expression and activation of p75NTR signalling cascades after the seizure have been shown, but the role of the p75 receptor in epilepsy-induced psychotic behaviors has not been documented so far. Therefore, the present work aimed to investigate the effect of p75 receptor blockade on seizure activity, irritability, and anxiety-like behaviors in a rat model of status epilepticus. Methods Rats were injected with pilocarpine (350 mg/ kg, i.p.) to induce status epilepticus. Then various behavioral tests were performed after the blockade of p75NTR alone or in combination with p75 antagonist and phenobarbital. Molecular analysis by PCR was performed to investigate the expression of p75 and pro-NGF. Results Molecular findings indicated a high level of mRNA expression for both p75 receptors and pro-NGF in the epileptic model group. Results also showed that the administration of p75 antagonist alone or in combination with phenobarbital was able to significantly influence the behavioral responses. Furthermore, 20-hours video monitoring showed a decrease in the frequency and duration of seizures in the rat group receiving p75 antagonist. Conclusion Taken together, the present study suggests that the blockade of the p75 receptor may affect the irritability and anxiety-related behavior in a rat model of status epilepticus.
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Affiliation(s)
- Soraya Mehrabi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahyar Janahamdi
- Neuroscience Research Center and Department of Physiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataie
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Barati
- Department of pharmaceutical biotechnology, School of pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Marzban
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoudreza Hadjighassem
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farahmandfar
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Reyes-Garcia SZ, Scorza CA, Araújo NS, Ortiz-Villatoro NN, Jardim AP, Centeno R, Yacubian EMT, Faber J, Cavalheiro EA. Different patterns of epileptiform-like activity are generated in the sclerotic hippocampus from patients with drug-resistant temporal lobe epilepsy. Sci Rep 2018; 8:7116. [PMID: 29740014 PMCID: PMC5940759 DOI: 10.1038/s41598-018-25378-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022] Open
Abstract
Human hippocampal slice preparations from patients with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS) are excellent material for the characterization of epileptiform-like activity. However, it is still unknown if hippocampal regions as cornu Ammonis (CA) 1, CA3 and CA4, generate population epileptiform-like activity. Here, we investigated epileptiform activities of the subiculum, CA1, CA2, CA3, CA4 (induced by elevation of extracellular potassium concentration) and the dentate gyrus (induced with hilar stimulation and elevation of potassium concentration) from sclerotic hippocampi of patients with drug-resistant TLE. Five types of epileptiform-like activity were observed: interictal-like events; periodic ictal spiking; seizure-like events; spreading depression-like events; tonic seizure-like events and no activity. Different susceptibilities to generate epileptiform activity among hippocampal regions were observed; the dentate gyrus was the most susceptible region followed by the subiculum, CA4, CA1, CA2 and CA3. The incidence of epileptiform activity pattern was associated with specific regions of the hippocampal formation. Moreover, it was observed that each region of the hippocampal formation exhibits frequency-specific ranges in each subfield of the sclerotic human tissue. In conclusion, this study demonstrates that epileptiform-like activity may be induced in different regions of the hippocampal formation, including regions that are severely affected by neuronal loss.
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Affiliation(s)
- Selvin Z Reyes-Garcia
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. .,Departamento de Ciencias Morfológicas, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.
| | - Carla A Scorza
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Noemi S Araújo
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Nancy N Ortiz-Villatoro
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Anaclara Prada Jardim
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ricardo Centeno
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elza Márcia Targas Yacubian
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jean Faber
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Esper A Cavalheiro
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Gonçalves EB, de Oliveira Cardoso TAM, Yasuda CL, Cendes F. Depressive disorders in patients with pharmaco-resistant mesial temporal lobe epilepsy. J Int Med Res 2018; 46:752-760. [PMID: 29239239 PMCID: PMC5971495 DOI: 10.1177/0300060517717825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
Objectives To assess depressive disorders in patients with mesial temporal lobe epilepsy (MTLE) refractory to medical treatment. Methods Adult patients with refractory MTLE completed two questionnaires (Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory (BDI) had a semi-structured psychiatric interview and a high resolution MRI scan. For complete neuropsychiatric diagnosis, as per International Classification of Diseases (ICD-10), the results were combined with clinical history and additional information from the patients' family. Results Of the 40 patients identified for this case series study which took place from 2008-2012, 31 (77.5%) had a depressive disorder: 14 had dysthymia, 11 had recurrent depressive disorder and 6 had bipolar disorder. Of the nine patients without a firm diagnosis of mood disorder, seven had isolated symptoms of depression or anxiety and two presented with mixed depression/anxiety symptoms. Only 8/31 (25.8%) patients were receiving antidepressant treatment. There was no association between BDI scores and seizure frequency. No significant difference was found between patients with and without depression and the presence or laterality of HA. Conclusions Depressive disorders are common, underdiagnosed and undertreated in patients with refractory MTLE.
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Affiliation(s)
| | | | - Clarissa Lin Yasuda
- Department of Neurology, University of Campinas – UNICAMP, Campinas, Sao Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, University of Campinas – UNICAMP, Campinas, Sao Paulo, Brazil
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Nogueira MH, Yasuda CL, Coan AC, Kanner AM, Cendes F. Concurrent mood and anxiety disorders are associated with pharmacoresistant seizures in patients with MTLE. Epilepsia 2017; 58:1268-1276. [PMID: 28555776 DOI: 10.1111/epi.13781] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate whether mood disorders (MD) and anxiety disorders (AD) are associated with seizure control in patients with mesial temporal lobe epilepsy (MTLE). We compared patients without any current psychiatric disorder, patients with current MD and/or AD, patients with subsyndromic depression episodes (SSDE) and anxiety episodes (SSAE), and patients with family psychiatric history. METHODS In a cross-sectional study, we included 144 consecutive patients with MTLE (82 pharmacoresistant and 62 treatment-responsive patients). Every patient underwent a psychiatric evaluation including the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis I (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Interictal Dysphoric Disorder Inventory (IDDI). Patients were divided into four groups: PsychNeg (G1, n = 61), current SSDE and SSAE (G2, n = 26), Current MD or AD (G3, n = 25), and current mixed MD/AD (G4, n = 32). RESULTS Among patients with pharmacoresistant MTLE, 68.3% (56/82) experienced symptoms of depression and/or anxiety (G2, G3, and G4) (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.41-5.53, p < 0.01). Patients with mixed MD/AD (G4, n = 24/32) were more likely to have pharmacoresistant MTLE (OR 4.04, 95% CI 1.57-10.42, p < 0.01) than psychiatric asymptomatic patients (G1, n = 26/61), and their seizure frequency was significantly higher (p < 0.01). Positive family psychiatric history was more frequent in pharmacoresistant patients (n = 27/82, OR 2.28, 95% CI 1.02-5.05, p = 0.04). Finally, 31.6% of patients with MD and or AD were not receiving psychiatric treatment. SIGNIFICANCE Identification of comorbid MD/AD and of family psychiatric history is of the essence in patients with MTLE, as they appear to be associated with worse seizure control.
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Affiliation(s)
- Mateus H Nogueira
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Clarissa L Yasuda
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Ana C Coan
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Fernando Cendes
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
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Schraegle WA, Titus JB. The relationship of seizure focus with depression, anxiety, and health-related quality of life in children and adolescents with epilepsy. Epilepsy Behav 2017; 68:115-122. [PMID: 28142130 DOI: 10.1016/j.yebeh.2016.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/30/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
For youth with epilepsy, comorbid psychiatric conditions, such as depression and anxiety, require further examination as they carry increased risk for reduced health-related quality of life (HRQOL). The current study assessed whether rates of depression, anxiety, and withdrawal behaviors differed based on seizure location. Data included parental ratings on the Behavior Assessment System for Children (BASC-2) and the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 132 children and adolescents (mean age=11.34, SD=3.95) with generalized or partial (i.e., frontal [FLE] or temporal lobe epilepsy [TLE]) epilepsy. Our results identified clinically significant internalizing psychopathology in nearly half of our sample (41%). Although rates of internalizing behavior were similar between generalized and partial groups, children and adolescents with TLE demonstrated higher rates of depression compared to youth with FLE. No effects of laterality on internalizing behaviors were identified between TLE and FLE groups. Finally, for youth with TLE, parental depression ratings along with current number of antiepileptic medications (AEDs) were found to be significant barriers to HRQOL above and beyond anxiety, withdrawal, and epilepsy-specific variables. Temporal lobe epilepsy was associated with a two-fold risk of clinically significant depression ratings. These findings highlight the high prevalence of internalizing psychopathology features in pediatric epilepsy and offer further support for the relationship between depression and TLE in children and adolescents with epilepsy.
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Affiliation(s)
- William A Schraegle
- Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, Austin, TX, USA; Department of Educational Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Jeffrey B Titus
- Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, Austin, TX, USA; Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
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Using Hospital Anxiety and Depression Scale (HADS) on patients with epilepsy: Confirmatory factor analysis and Rasch models. Seizure 2016; 45:42-46. [PMID: 27915110 DOI: 10.1016/j.seizure.2016.11.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/24/2016] [Accepted: 11/24/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The problems of mood disorders are critical in people with epilepsy. Therefore, there is a need to validate a useful tool for the population. The Hospital Anxiety and Depression Scale (HADS) has been used on the population, and showed that it is a satisfactory screening tool. However, more evidence on its construct validity is needed. METHOD A total of 1041 people with epilepsy were recruited in this study, and each completed the HADS. Confirmatory factor analysis (CFA) and Rasch analysis were used to understand the construct validity of the HADS. In addition, internal consistency was tested using Cronbachs' α, person separation reliability, and item separation reliability. Ordering of the response descriptors and the differential item functioning (DIF) were examined using the Rasch models. RESULTS The HADS showed that 55.3% of our participants had anxiety; 56.0% had depression based on its cutoffs. CFA and Rasch analyses both showed the satisfactory construct validity of the HADS; the internal consistency was also acceptable (α=0.82 in anxiety and 0.79 in depression; person separation reliability=0.82 in anxiety and 0.73 in depression; item separation reliability=0.98 in anxiety and 0.91 in depression). The difficulties of the four-point Likert scale used in the HADS were monotonically increased, which indicates no disordering response categories. No DIF items across male and female patients and across types of epilepsy were displayed in the HADS. CONCLUSIONS The HADS has promising psychometric properties on construct validity in people with epilepsy. Moreover, the additive item score is supported for calculating the cutoff.
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Abstract
Temporal lobe epilepsy (TLE) is a prevalent neurodegenerative disease associated with various neuropsychiatric disorders and decreased quality of life. Much has been said about the use of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET), magnetic resonance imaging (MRI), and computed tomography in the qualitative assessment of TLE. However, research into the applications of quantitative measurements to treat and diagnose TLE is severely lacking in the literature. Global quantitative analysis using 18F-FDG-PET is a powerful tool in the metabolic assessment of TLE, and can more accurately identify seizure lateralization and the potential effects of treatment as compared with visual assessments and traditional biopsy region-of-interest quantification. Therefore, there is a pressing need to introduce these novel methods to the treatment of TLE. Although 18F-FDG-PET is most commonly used for visual assessments, qualitative analysis is associated with high levels of interobserver and intraobserver variability. Semiquantitative analysis using standardized uptake value is a more consistently accurate measure of the hypometabolic patterns seen in TLE patients. Novel methods of global quantitative analysis developed in our laboratory have the potential to improve TLE assessment by limiting variability and correcting for the partial volume effect. It is of great importance to adopt these techniques into the mainstream diagnosis and treatment of TLE in order to improve patient care worldwide.
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Chen SD, Wang YL, Liang SF, Shaw FZ. Rapid Amygdala Kindling Causes Motor Seizure and Comorbidity of Anxiety- and Depression-Like Behaviors in Rats. Front Behav Neurosci 2016; 10:129. [PMID: 27445726 PMCID: PMC4916743 DOI: 10.3389/fnbeh.2016.00129] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022] Open
Abstract
Amygdala kindling is a model of temporal lobe epilepsy (TLE) with convulsion. The rapid amygdala kindling has an advantage on quick development of motor seizures and for antiepileptic drugs screening. The rapid amygdala kindling causes epileptogenesis accompanied by an anxiolytic response in early isolation of rat pups or depressive behavior in immature rats. However, the effect of rapid amygdala kindling on comorbidity of anxiety- and depression-like behaviors is unexplored in adult rats with normal breeding. In the present study, 40 amygdala stimulations given within 2 days were applied in adult Wistar rats. Afterdischarge (AD) and seizure stage were recorded throughout the amygdala kindling. Anxiety-like behaviors were evaluated by the elevated plus maze (EPM) test and open field (OF) test, whereas depression-like behaviors were assessed by the forced swim (FS) and sucrose consumption (SC) tests. A tonic-clonic convulsion was provoked in the kindle group. Rapid amygdala kindling resulted in a significantly lower frequency entering an open area of either open arms of the EPM or the central zone of an OF, lower sucrose intake, and longer immobility of the FS test in the kindle group. Our results suggest that rapid amygdala kindling elicited severe motor seizures comorbid with anxiety- and depression-like behaviors.
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Affiliation(s)
- Shang-Der Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan; Center for Translational Research in Biomedical Science, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Yu-Lin Wang
- Department of Computer Science and Information Engineering, National Cheng Kung University Tainan, Taiwan
| | - Sheng-Fu Liang
- Department of Computer Science and Information Engineering, National Cheng Kung UniversityTainan, Taiwan; Institute of Medical Informatics, National Cheng Kung UniversityTainan, Taiwan
| | - Fu-Zen Shaw
- Department of Psychology, National Cheng Kung University Tainan, Taiwan
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