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Wen W, Zhou J, Zhan C, Wang J. Microglia as a Game Changer in Epilepsy Comorbid Depression. Mol Neurobiol 2024; 61:4021-4037. [PMID: 38048030 DOI: 10.1007/s12035-023-03810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
As one of the most common neurological diseases, epilepsy is often accompanied by psychiatric disorders. Depression is the most universal comorbidity of epilepsy, especially in temporal lobe epilepsy (TLE). Therefore, it is urgently needed to figure out potential mechanisms and the optimization of therapeutic strategies. Microglia play a pivotal role in the coexistent relationship between epilepsy and depression. Activated microglia released cytokines like IL-6 and IL-1β, orchestrating neuroinflammation especially in the hippocampus, worsening both depression and epilepsy. The decrease of intracellular K+ is a common part in various molecular changes. The P2X7-NLRP3-IL-1β is a major inflammatory pathway that disrupts brain network. Extra ATP and CX3CL1 also lead to neuronal excitotoxicity and blood-brain barrier (BBB) disruption. Regulating neuroinflammation aiming at microglia-related molecules is capable of suspending the vicious mutual aggravating circle of epilepsy and depression. Other overlaps between epilepsy and depression lie in transcriptomic, neuroimaging, diagnosis and treatment. Hippocampal sclerosis (HS) and amygdala enlargement (AE) may be the underlying macroscopic pathological changes according to current studies. Extant evidence shows that cognitive behavioral therapy (CBT) and antidepressants like selective serotonin-reuptake inhibitors (SSRIs) are safe, but the effect is limited. Improvement in depression is likely to reduce the frequency of seizure. More comprehensive experiments are warranted to better understand the relationship between them.
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Affiliation(s)
- Wenrong Wen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou Avenue North, Guangzhou, 1838, Guangdong Province, China
- The First Clinical Medicine College, Southern Medical University, Guangzhou, Guangdong Province, China
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jingsheng Zhou
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou Avenue North, Guangzhou, 1838, Guangdong Province, China
- The First Clinical Medicine College, Southern Medical University, Guangzhou, Guangdong Province, China
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Chang'an Zhan
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jun Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou Avenue North, Guangzhou, 1838, Guangdong Province, China.
- The First Clinical Medicine College, Southern Medical University, Guangzhou, Guangdong Province, China.
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, Guangdong Province, China.
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Cobb SJ, Beebe LH. Quality of Life in Psychogenic Nonepileptic Seizures: An Evolutionary Concept Analysis. Issues Ment Health Nurs 2022; 43:730-736. [PMID: 35148236 DOI: 10.1080/01612840.2022.2035026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) pose a serious threat to quality of life (QOL) in patients who battle the disorder. As psychological treatment options have progressed, improvement in QOL has become a more common desired outcome. Despite its relevance in PNES research and treatment, QOL has not been defined in the PNES population. Rodgers' Evolutionary Method of concept analysis was used to analyze 47 articles and clarify the concept of QOL in PNES. QOL in PNES is subjective, multidimensional, associated with symptoms, and dynamic in nature. This conceptualization of QOL in PNES may be useful in future PNES research and treatment.
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Affiliation(s)
- Sandra J Cobb
- College of Nursing, University of Tennessee Knoxville, Knoxville, Tennessee, USA
| | - Lora Humphrey Beebe
- College of Nursing, University of Tennessee Knoxville, Knoxville, Tennessee, USA
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Cobb SJ, Vaughn BV, Sagherian K. Nonpharmacologic Interventions and Seizure Frequency in Patients With Psychogenic Nonepileptic Seizures: An Integrative Review. J Am Psychiatr Nurses Assoc 2022:10783903221107637. [PMID: 35801259 DOI: 10.1177/10783903221107637] [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
BACKGROUND Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices. AIM To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES. METHODS An integrative review guided by the Whittemore and Knafl approach. RESULTS The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies). CONCLUSIONS Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.
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Affiliation(s)
- Sandra J Cobb
- Sandra J. Cobb, MSN, FNP-C, RN, REEGT, PhD in nursing candidate, University of Tennessee Knoxville, College of Nursing, Knoxville, TN, USA
| | - Bradley V Vaughn
- Bradley V. Vaughn, MD, Professor, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Knar Sagherian
- Knar Sagherian, PhD, RN, Assistant Professor, University of Tennessee Knoxville College of Nursing, Knoxville, TN, USA
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Myers L, Sarudiansky M, Korman G, Baslet G. Using evidence-based psychotherapy to tailor treatment for patients with functional neurological disorders. Epilepsy Behav Rep 2021; 16:100478. [PMID: 34693243 PMCID: PMC8515382 DOI: 10.1016/j.ebr.2021.100478] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 01/08/2023] Open
Abstract
Functional neurological disorder (FND) frequently presents with comorbid psychopathology (e.g., anxiety, depressive, post-traumatic stress disorders (PTSD), somatic symptom and pain syndromes, and dissociative and personality disorders). It can become chronic and lead to unemployment and disability for many patients. Psychosocial factors play an important role in the onset and perpetuation of symptoms. Consequently, psychotherapy is recommended for the treatment of FND in general, and especially for the single symptom-based subtype of functional seizures (FS). Some of the psychotherapy approaches that have been utilized for FND include cognitive-behavioral therapy (CBT), third wave approaches, and psychodynamic psychotherapies as well as group therapeutic and psychoeducational interventions. For patients with FS and PTSD, prolonged exposure therapy, a CBT-based treatment has been implemented. The purpose of this manuscript is to describe and analyze specific elements (e.g., theoretical foundations, tools, targets, definitions of success) of the main psychotherapeutic approaches used in patients with FND. Our premise is that these modalities will overlap considerably in some respects. We will conclude by discussing how discrete differences may render them more suitable for subgroups of patients with FND or for patients at different timepoints of their recovery process.
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Affiliation(s)
- Lorna Myers
- Northeast Regional Epilepsy Group, United States
| | - Mercedes Sarudiansky
- National Council for Scientific and Technical Research (CONICET), Institute of Research in Psychology, Faculty of Psychology, University of Buenos Aires, Argentina
| | - Guido Korman
- National Council for Scientific and Technical Research (CONICET), Institute of Research in Psychology, Faculty of Psychology, University of Buenos Aires, Argentina
| | - Gaston Baslet
- Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Liu Q, Wang L, Yan G, Zhang W, Huan Z, Li J. MiR-125a-5p Alleviates Dysfunction and Inflammation of Pentylenetetrazol- induced Epilepsy Through Targeting Calmodulin-dependent Protein Kinase IV (CAMK4). Curr Neurovasc Res 2020; 16:365-372. [PMID: 31490757 DOI: 10.2174/1567202616666190906125444] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND MicroRNAs (miRNA) are known to play a key role in the etiology and treatment of epilepsy through controlling the expression of gene. However, miR-125a-5p in the epilepsy is little known. Epilepsy in rat models was induced by Pentylenetetrazol (PTZ) and miR- 125a-5p profiles in the hippocampus were investigated in our experiment. Also, the relationship between miR-125a-5p and calmodulin-dependent protein kinase IV (CAMK4) was identified and the related mechanism was also illustrated. METHODS The miR-125a-5p mRNA expression levels were evaluated by quantitative real time polymerase chain reaction (qRT-PCR). Western Blot (WB) was used to analyze the CAMK4 protein expression levels. Seizure score, latency and duration were determined based on a Racine scale. The enzyme-linked immunosorbent assay (ELISA) was used to analyze the inflammatory factor expression. The relationship between miR-125a-5p and CAMK4 was detected through dual luciferase assay. RESULTS Downregulation of miR-125a-5p was observed in the hippocampus of PTZ-induced epilepsy rats. The overexpression of miR-125a-5p attenuated seizure and decreased inflammatory factor level in the hippocampus of PTZ-induced rats. The miR-125a-5p alleviated epileptic seizure and inflammation in PTZ-induced rats by suppressing its target gene, CAMK4. CONCLUSION miR-125a-5p may represent a novel therapeutic treatment for PTZ-induced epilepsy by preventing the activation of CAMK4.
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Affiliation(s)
- Qishuai Liu
- Department of Neurology, The First Hospital of Zibo, Zibo City, Shandong Province, 255200, China
| | - Li Wang
- Department of Nephrology, The First Hospital of Zibo, Zibo City, Shandong Province, 255200, China
| | - Guizhen Yan
- Department of Neurology, People's Hospital of Lixia District of Jinan, Jinan City, Shandong Province, 250014, China
| | - Weifa Zhang
- Department of Neurology, The First Hospital of Zibo, Zibo City, Shandong Province, 255200, China
| | - Zhigang Huan
- Department of Neurology, The First Hospital of Zibo, Zibo City, Shandong Province, 255200, China
| | - Jianyuan Li
- Department of Neursurgery, Rizhao City Hospital of TCM, Rizhao City, Shandong Province, 276800, China
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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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Yu JN, Yue CF, Wang KJ, Chi NN, Li X. Effect of cinnamaldehyde on Cav-1 and Survivin expression in epilepsy: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20459. [PMID: 32501993 PMCID: PMC7306385 DOI: 10.1097/md.0000000000020459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This systematic review aims to assess the effect of cinnamaldehyde on Cav-1 and Survivin expression in epilepsy. METHODS We will search Cochrane Library, PUBMED, EMBASE, CINAHL, Web of Science, Google Scholar, PsycINFO, WANGFANG, VIP, CBM, and CNKI from their inceptions to the March 31, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. RevMan 5.3 software will be used for statistical analysis. RESULTS This systematic review will investigate whether cinnamaldehyde is effective on Cav-1 and Survivin expression in epilepsy. CONCLUSION Its findings will provide helpful evidence for the effect of cinnamaldehyde on Cav-1 and Survivin expression in epilepsy.Systematic review registration: INPLASY202040152.
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Affiliation(s)
| | | | | | | | - Xin Li
- First Ward of Neurology Department, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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Cognitive Behavioral Therapy (CBT) in Psychogenic Non-Epileptic Seizures (PNES): A Case Report and Literature Review. Behav Sci (Basel) 2019; 9:bs9020015. [PMID: 30699899 PMCID: PMC6406384 DOI: 10.3390/bs9020015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 12/14/2022] Open
Abstract
Psychogenic non-epileptic seizures (PNES) are classified as a somatoform conversion disorder. We present a case of a 24-year-old male with a past psychiatric history of posttraumatic stress disorder (PTSD) and anxiety disorder, admitted to our inpatient psychiatric unit. The patient experienced multiple episodes of seizures during hospitalization. Work up was unremarkable, and PNES were suspected and later confirmed with video-electroencephalography (video-EEG). He underwent supervised withdrawal of antiepileptic medications with the initiation of cognitive behavioral therapy (CBT), which reduced the frequency of seizures. Diagnosis of PNES can present as a challenge and failure to diagnose its psychological nature can lead to a delay in the psychological intervention. CBT leads to a decrease in seizure frequency, and improvement in psychiatric symptoms, psychosocial functioning, and quality of life. It is important to consider PNES in the differential diagnosis of seizures presented by psychiatric patients, as CBT is necessary for better patient outcomes.
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