1
|
Chen L, He XH, Li XL, Yang J, Huang H. Bibliometric analysis of research in epilepsy and comorbid depression from 2014 to 2023. World J Psychiatry 2024; 14:985-998. [PMID: 38984335 PMCID: PMC11230101 DOI: 10.5498/wjp.v14.i6.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Epilepsy and depression have complicated bidirectional relationships. Our study aimed to explore the field of epilepsy comorbid with depression in a bibliometric perspective from 2014-2023. AIM To improve our understanding of epilepsy and depression by evaluating the relationship between epilepsy and depression, bibliometric analyses were performed. METHODS Epilepsy and depression-related publications from the last decade were retrieved from the Web of Science Core Collection. We conducted bibliometric and visual analysis using VOSviewer and CiteSpace, examining authorships, countries, institutions, journals of publication, co-citations of references, connections between keywords, clusters of keywords, and keywords with citation bursts. RESULTS Over the past ten years, we collected 1045 research papers focusing on the field of epilepsy and comorbid depression. Publications on epilepsy and depression have shown a general upward trend over time, though with some fluctuations. The United States, with 287 articles, and the University of Melbourne, contributing 34 articles, were the top countries and institutions, respectively. In addition, in the field of epilepsy and depression, Professor Lee, who has published 30 articles, was the most contributing author. The hot topics pay attention to the quality of life in patients with epilepsy and depression. CONCLUSION We reported that quality of life and stigma in patients with epilepsy comorbid with depression are possible future hot topics and directions in the field of epilepsy and depression research.
Collapse
Affiliation(s)
- Ling Chen
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Xiao-Hui He
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400010, China
| | - Xia-Ling Li
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400010, China
| | - Juan Yang
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Hao Huang
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| |
Collapse
|
2
|
Conner K, Gandy M, Munger-Clary HM. What is the role of screening instruments in the management of psychiatric comorbidities in epilepsy? Tools and practical tips for the most common comorbidities: Depression and anxiety. Epilepsy Behav Rep 2024; 25:100654. [PMID: 38389991 PMCID: PMC10881315 DOI: 10.1016/j.ebr.2024.100654] [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: 10/31/2023] [Revised: 12/13/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
Depression and anxiety are the most common psychiatric comorbidities in epilepsy and are known to increase healthcare utilization, the risk of refractory epilepsy, and anti-seizure medication intolerability. Despite this, depression and anxiety continue to be underrecognized and undertreated in people with epilepsy (PWE). Several barriers to the identification of depression and anxiety in PWE exist, including reliance on unstructured interviews rather than standardized, validated instruments. Moreover, there is a dearth of behavioral health providers to manage these comorbidities once identified. The use of validated screening instruments in epilepsy clinics can assist with both the identification of psychiatric symptoms and monitoring of treatment response by the epilepsy clinician for PWE with comorbid depression and/or anxiety. While screening instruments can identify psychiatric symptoms occurring within a specified time, they are not definitively diagnostic. Screeners can be time efficient tools to identify patients requiring further evaluation for diagnostic confirmation. This article reviews recent literature on the utility of depression and anxiety screening instruments in epilepsy care, including commonly used screening instruments, and provides solutions for potential barriers to clinical implementation. Validated depression and anxiety screening instruments can increase identification of depression and anxiety and guide epilepsy clinician management of these comorbidities which has the potential to positively impact patient care.
Collapse
Affiliation(s)
- Kelly Conner
- Department of Physician Assistant Studies, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Milena Gandy
- The School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Heidi M Munger-Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| |
Collapse
|
3
|
Temple J, Fisher P, Davies C, Millar C, Gemma Cherry M. Psychosocial factors associated with anxiety and depression in adolescents with epilepsy: A systematic review. Epilepsy Behav 2023; 149:109522. [PMID: 38006843 DOI: 10.1016/j.yebeh.2023.109522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/27/2023]
Abstract
Anxiety and depression are common in adolescents with epilepsy. Identifying psychosocial risk factors for anxiety and depression is essential for adolescents with epilepsy to receive appropriate support. This systematic review synthesised findings of studies examining the relationship between psychosocial factors and anxiety and/or depression in adolescents with epilepsy. Outcomes were anxiety, depression, and mixed anxiety & depression. Six electronic databases were searched for studies which: used cross-sectional or prospective designs; quantitatively evaluated the relationship between psychosocial factors and anxiety and/or depression; presented results for adolescents with epilepsy aged 9-18 years; and used validated measures of anxiety and/or depression. Psychosocial factors were categorised as intrapersonal, interpersonal, or parent-specific factors. Sixteen studies (23 articles) were included. All but one were cross-sectional. Regarding intrapersonal factors, alternative mental health difficulties were consistently positively associated with all three outcomes. Negative attitude towards epilepsy, lower seizure self-efficacy, lower self-esteem and stigma were consistently positively associated with depression. Interpersonal factors (i.e., lower family functioning assessed from an adolescent's perspective) and parent-specific factors (i.e., parental stigma, stress, anxiety and psychopathology) were positively associated with at least one outcome. Adolescent epilepsy management should exceed assessment of biological/biomedical factors and incorporate assessment of psychosocial risk factors. Prospective studies examining the interplay between biological/biomedical factors and the psychosocial factors underpinning anxiety and depression in adolescents with epilepsy are needed.
Collapse
Affiliation(s)
- James Temple
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK
| | - Cari Davies
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Chris Millar
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK.
| |
Collapse
|
4
|
Kritzer MD, Peterchev AV, Camprodon JA. Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions. Harv Rev Psychiatry 2023; 31:101-113. [PMID: 37171471 PMCID: PMC10198476 DOI: 10.1097/hrp.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
LEARNING OBJECTIVES • Outline and discuss the fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes• Summarize the overview of ECT, its efficacy in treating depression, the known effects on cognition, evidence of mechanisms, and future directions. ABSTRACT Electroconvulsive therapy (ECT) is the most effective treatment for a variety of psychiatric illnesses, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia. ECT is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure. ECT has evolved a great deal since the 1930s. Though it has been optimized for safety and to reduce adverse effects on cognition, issues persist. There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes. Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT. This narrative review provides an overview of ECT, its efficacy in treating depression, its known effects on cognition, evidence of its mechanisms, and future directions.
Collapse
Affiliation(s)
- Michael D Kritzer
- From the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA (Drs. Kritzer, Camprodon); Department of Psychiatry and Behavioral Sciences, Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Department of Neurosurgery, Duke University, Durham, NC (Dr. Peterchev)
| | | | | |
Collapse
|
5
|
Pawar SD, Gawali K, Kulhari H, Murty US, Kumar P. Amoxapine-Loaded Solid Lipid Nanoparticles with Superior Preclinical Pharmacokinetics for Better Brain Delivery: LC-MS/MS and GC-MS Analysis. ACS Chem Neurosci 2023. [PMID: 37027804 DOI: 10.1021/acschemneuro.2c00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
The tricyclic antidepressant amoxapine (AMX) has been reported for a rapid onset of action compared to other cyclic antidepressants. It has very low solubility and bioavailability due to first-pass metabolism. Therefore, we planned to develop solid lipid nanoparticles (SLNs) of AMX using a single emulsification method to increase its solubility and bioavailability. HPLC and LC-MS/MS methods were developed further to quantify AMX in the formulation, plasma, and brain tissue samples. The formulation was studied for entrapment efficiency, loading, and in vitro drug release. Particle size and ζ potential analyses, AFM, SEM, TEM, DSC, and XRD were used for further characterization. In vivo oral pharmacokinetic and brain pharmacokinetic studies were performed using Wistar rats. The entrapment and loading efficiencies of AMX in SLNs were 85.8 ± 3.42 and 4.5 ± 0.45%, respectively. The developed formulation had a mean particle size of 151.5 ± 7.02 nm and a polydispersity index of 0.40 ± 0.11. DSC and XRD results indicated that AMX was incorporated into the nanocarrier system in an amorphous form. SEM, TEM, and AFM studies of AMX-SLNs confirmed the particles' spherical shape and nanoscale size. AMX solubility increased by approx. 2.67 times compared to the pure drug. The developed LC-MS/MS method was successfully applied to the oral and brain pharmacokinetic study of AMX-loaded SLNs in rats. Oral bioavailability was enhanced 1.6 times compared to the pure drug. The peak plasma concentrations of pure AMX and AMX-SLNs were 617.4 ± 137.4 and 1043.5 ± 150.2 (ng/mL), respectively. AMX-SLNs showed more than 5.8 times brain concentration compared to the pure drug. Based on the findings, it appears that utilizing a solid lipid nanoparticle carrier to transport AMX can be a highly effective delivery method with improved pharmacokinetic properties in the brain. This approach may prove valuable for future antidepressant treatment.
Collapse
Affiliation(s)
- Sachin Dattram Pawar
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research-Guwahati, Sila Katamur (Halugurisuk), Post Office Changsari, Kamrup, Assam 781101, India
| | - Komal Gawali
- Department of Pharmaceutical Technology (Formulations), National Institute of Pharmaceutical Education and Research-Guwahati, Sila Katamur (Halugurisuk), Post Office Changsari, Kamrup, Assam 781101, India
| | - Hitesh Kulhari
- Department of Pharmaceutical Technology (Formulations), National Institute of Pharmaceutical Education and Research-Guwahati, Sila Katamur (Halugurisuk), Post Office Changsari, Kamrup, Assam 781101, India
- School of Nano Sciences, Central University of Gujarat, Gandhinagar 382030, India
| | - Upadhyayula Suryanarayana Murty
- Department of Pharmaceutical Technology (Formulations), National Institute of Pharmaceutical Education and Research-Guwahati, Sila Katamur (Halugurisuk), Post Office Changsari, Kamrup, Assam 781101, India
| | - Pramod Kumar
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research-Guwahati, Sila Katamur (Halugurisuk), Post Office Changsari, Kamrup, Assam 781101, India
| |
Collapse
|
6
|
Manole AM, Sirbu CA, Mititelu MR, Vasiliu O, Lorusso L, Sirbu OM, Ionita Radu F. State of the Art and Challenges in Epilepsy—A Narrative Review. J Pers Med 2023; 13:jpm13040623. [PMID: 37109008 PMCID: PMC10140944 DOI: 10.3390/jpm13040623] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Epilepsy is a common condition worldwide, with approximately 50 million people suffering from it. A single seizure does not mean epilepsy; almost 10% of the population can have a seizure during their lifetime. In particular, there are many other central nervous system disorders other than epilepsy in which seizures occur, either transiently or as a comorbid condition. The impact of seizures and epilepsy is, therefore, widespread and easily underestimated. It is estimated that about 70% of patients with epilepsy could be seizure-free if correctly diagnosed and treated. However, for patients with epilepsy, quality of life is influenced not only by seizure control but also by antiepileptic drug-adverse reactions, access to education, mood, employment, and transportation.
Collapse
Affiliation(s)
- Aida Mihaela Manole
- Department of Neurology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Carmen Adella Sirbu
- Department of Neurology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania
- Clinical Neurosciences Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (Neuropsy-Cog), Department of Neurology, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Mihaela Raluca Mititelu
- Nuclear Medicine Department, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania
- Department No.8, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
| | - Octavian Vasiliu
- Department of Psychiatry, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242, Bucharest, Romania
| | - Lorenzo Lorusso
- Neurology Unit—Neuroscience Dept. A.S.S.T.Lecco, Merate Hospital, 23807 Merate, Italy
| | - Octavian Mihai Sirbu
- Clinical Neurosciences Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
- Department of Neurosurgery, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Florentina Ionita Radu
- Department of Gastroenterology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
7
|
Villanueva V, Artal J, Cabeza-Alvarez CI, Campos D, Castillo A, Flórez G, Franco-Martin M, García-Portilla MP, Giráldez BG, Gotor F, Gutiérrez-Rojas L, Albanell AM, Paniagua G, Pintor L, Poza JJ, Rubio-Granero T, Toledo M, Tortosa-Conesa D, Rodríguez-Uranga J, Bobes J. Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus. Neurol Ther 2023; 12:479-503. [PMID: 36692706 PMCID: PMC10043101 DOI: 10.1007/s40120-023-00437-0] [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: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE. METHODS This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations. RESULTS Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide. CONCLUSION We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.
Collapse
Affiliation(s)
- Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Jesús Artal
- Psychiatry Department, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Spain.
| | | | - Dulce Campos
- Neurology Department, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Ascensión Castillo
- Neurology Department, Consorcio Hospital General Universitario Valencia, Valencia, Spain
| | - Gerardo Flórez
- Psychiatry Department, Addiction Treatment Unit, Orense, Spain
| | - Manuel Franco-Martin
- Psychiatry Department, Zamora Hospital (Complejo Asistencial de Zamora), Zamora, Spain
| | - María Paz García-Portilla
- Psychiatry Department, University of Oviedo, ISPA, CIBERSAM, INEUROPA, and Mental Health Services of Principality of Asturias, Oviedo, Spain
| | - Beatriz G Giráldez
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francisco Gotor
- Psychiatry Department, School of Medicine, University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - Gonzalo Paniagua
- Psychiatry Department, University of Oviedo, Oviedo, Spain.,Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Luis Pintor
- Psychiatry Department, Hospital Clínico of Barcelona, Barcelona, Spain
| | - Juan José Poza
- Neurology Department, Hospital Universitario Donostia, Donostia, Spain
| | - Teresa Rubio-Granero
- Psychiatry Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Toledo
- Epilepsy Unit, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Diego Tortosa-Conesa
- Neurology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Julio Bobes
- Medicine-Psychiatry, Universidad de Oviedo, Oviedo, Spain
| |
Collapse
|
8
|
Li D, Song Y, Zhang S, Qiu J, Zhang R, Wu J, Wu Z, Wei J, Xiang X, Zhang Y, Yu L, Wang H, Niu P, Fan C, Li X. Cognitive behavior therapy for depression in people with epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2023; 138:109056. [PMID: 36571868 DOI: 10.1016/j.yebeh.2022.109056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is the recommended treatment for depression in patients with epilepsy (PWE). However, there are no studies that calculate the effect size of CBT on depression and quality of life (QoL) in PWE. METHODS We searched seven electronic databases (PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials, Ovid Medline, and PsycINFO). We included 13 studies examining CBT for depression in PWE and calculated its effect size. RESULTS A total of 13 studies met the criteria. After treatment, CBT improves depression in PWE (g = 0.36, 95%CI: 0.18 to 0.54, I2 = 50%), and the efficacy maintains during follow-up (g = 0.47, 95%CI: 0.04 to 0.89, I2 = 80%). Subgroup analysis has shown that individual CBT (g = 0.47, 95%CI: 0.20 to 0.73, I2 = 0%) had a greater effect size than group CBT (g = 0.30, 95%CI: 0.07 to 0.53, I2 = 62%) in the treatment of depression. Likewise, CBT has a positive effect on the QoL improvement of PWE (g = 0.34, 95%CI: 0.11 to 0.57, I2 = 64%). In controlling seizures, CBT did not differ from the control group (g = -0.06, 95%CI: -0.32 to 0.19, I2 = 0%). CONCLUSIONS Cognitive behavioral therapy interventions were effective in improving depression and QoL in PWE, but not effective in controlling seizures. The efficacy of CBT interventions targeting seizure control seems to be uncertain.
Collapse
Affiliation(s)
- Dongxu Li
- Research Center for Translational Medicine, the Second Hospital of Anhui Medical University, Hefei, China; Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China; Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Yuqi Song
- Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Shuyu Zhang
- School of Psychology, The Australian National University, Canberra, ACT 2601, Australia
| | - Juan Qiu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Rui Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Jiayi Wu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Ziyan Wu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Junwen Wei
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Xuefeng Xiang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Yue Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Liangdong Yu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Honghan Wang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Ping Niu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Chuan Fan
- Department of Psychiatry, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Xiaoming Li
- Research Center for Translational Medicine, the Second Hospital of Anhui Medical University, Hefei, China; Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
9
|
Dunn DW, Austin JK. An appreciation of Steven Schachter. Epilepsy Behav 2022; 137:108775. [PMID: 36463031 DOI: 10.1016/j.yebeh.2022.108775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 12/02/2022]
Affiliation(s)
- David W Dunn
- Departments of Psychiatry and Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Joan K Austin
- Indiana University School of Nursing, Indianapolis, IN, USA
| |
Collapse
|
10
|
Mula M, Brodie MJ, de Toffol B, Guekht A, Hecimovic H, Kanemoto K, Kanner AM, Teixeira AL, Wilson SJ. ILAE clinical practice recommendations for the medical treatment of depression in adults with epilepsy. Epilepsia 2021; 63:316-334. [PMID: 34866176 DOI: 10.1111/epi.17140] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 12/20/2022]
Abstract
The aim of this document is to provide evidence-based recommendations for the medical treatment of depression in adults with epilepsy. The working group consisted of members of an ad hoc Task Force of the International League Against Epilepsy (ILAE) Commission on Psychiatry, ILAE Executive and the International Bureau for Epilepsy (IBE) representatives. The development of these recommendations is based on a systematic review of studies on the treatment of depression in adults with epilepsy, and a formal adaptation process of existing guidelines and recommendations of treatment of depression outside epilepsy using the ADAPTE process. The systematic review identified 11 studies on drug treatments (788 participants, class of evidence III and IV); 13 studies on psychological treatments (998 participants, class of evidence II, III and IV); and 2 studies comparing sertraline with cognitive behavioral therapy (CBT; 155 participants, class of evidence I and IV). The ADAPTE process identified the World Federation of Societies of Biological Psychiatry guidelines for the biological treatment of unipolar depression as the starting point for the adaptation process. This document focuses on first-line drug treatment, inadequate response to first-line antidepressant treatment, and duration of such treatment and augmentation strategies within the broader context of electroconvulsive therapy, psychological, and other treatments. For mild depressive episodes, psychological interventions are first-line treatments, and where medication is used, selective serotonin reuptake inhibitors (SSRIs) are first-choice medications (Level B). SSRIs remain the first-choice medications (Level B) for moderate to severe depressive episodes; however, in patients who are partially or non-responding to first-line treatment, switching to venlafaxine appears legitimate (Level C). Antidepressant treatment should be maintained for at least 6 months following remission from a first depressive episode but it should be prolonged to 9 months in patients with a history of previous episodes and should continue even longer in severe depression or in cases of residual symptomatology until such symptoms have subsided.
Collapse
Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospital NHS Foundation Trust, London, UK
| | | | - Bertrand de Toffol
- Department of Neurology and Clinical Neurophysiology, CHU Bretonneau, INSERM U 1253 ibrain, Université de Tours, Tours, France
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University, Moscow, Russia
| | - Hrvoje Hecimovic
- Neuro Center, Zagreb, Croatia.,Department of Biomedicine, University North, Varaždin, Croatia
| | - Kousuke Kanemoto
- Department of Neuropsychiatry, Aichi Medical University, Nagoya, Japan
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Antonio L Teixeira
- Instituto de Ensino e Pesquisa, Santa Casa BH Belo Horizonte, Belo Horizonte, Brasil.,Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne and Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Rashid H, Upadhyay AD, Pandey RM, Katyal J. Point prevalence of depression in persons with active epilepsy and impact of methodological moderators: A systematic review and meta-analysis. Epilepsy Behav 2021; 125:108394. [PMID: 34794012 DOI: 10.1016/j.yebeh.2021.108394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to determine the pooled prevalence of depression in persons with epilepsy and assess the methodological moderators affecting the prevalence estimates. METHODS Five electronic databases PubMed, The Cochrane Library, EMBASE, WHO Global Index Medicus, and Clinicaltrial.gov were searched for studies reporting prevalence of depression in PWE ≥ 18 years of age in any setting. RESULTS Out of 13,873 studies, after deduplication and screening, 56 studies with 10,527 PWE met the eligibility criteria. The overall pooled prevalence of depression in PWE was 32% (95%confidence interval [CI] 28-35%) and significant heterogeneity (Chi-square = 1171.53, p = 0.00; τ2 = 0.02; I2 = 94.36%). Prevalence has doubled in the recent years (16% in 2000-2005 vs. 35% in 2016-2020), was higher in Asia than in Europe (coefficient 0.899, 95%CI: 0.809-0.999; p = 0.049). Among assessment methods, prevalence was highest in HAM-D scale (54%, 95%CI: 27-82%) and lowest in MINI (22%, 95%CI: 19-26%). Sensitivity analysis also corroborated findings when MINI was excluded (35%, 95%CI: 31-38%). CONCLUSIONS A significant proportion of PWE have depression. Though there is substantial heterogeneity due to various methodological moderators, it is unlikely to affect the routine screening of PWE for depression. Use of a screening tool should be based on ease of administration, and cutoff selection should ensure identification of minimal depression as well.
Collapse
Affiliation(s)
- Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashish D Upadhyay
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| |
Collapse
|
12
|
Zhong R, Chen Q, Li M, Lu Y, Zhao Q, Zhang X, Lin W. Factors contributing to comorbid depressive symptoms in adult people with newly diagnosed epilepsy: A 12-month longitudinal study. Epilepsy Behav 2021; 124:108326. [PMID: 34619545 DOI: 10.1016/j.yebeh.2021.108326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/04/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to investigate the point prevalence of comorbid depressive symptoms from the time of newly diagnosed epilepsy to 12 months and to identify the factors contributing to comorbid depressive symptoms over a 12-month period in patients with newly diagnosed epilepsy (PWNDE). METHODS A consecutive cohort of PWNDE from the First Hospital of Jilin University was recruited. Depressive symptoms were evaluated using the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy scale (C-NDDI-E). Multivariate stepwise logistic regression models were used to confirm the factors contributing to depressive symptoms in patients. RESULTS The point prevalence of depressive symptoms among PWNDE slightly decreased from 24.8% at baseline to 22.3% at 12 months. A MoCA score < 26 was identified as an independent risk factor contributing to depressive symptoms at baseline (OR = 2.419, 95% CI: 1.093-5.350, P = 0.029) and at 12 months (OR = 3.007, 95% CI: 1.223-7.390, P = 0.016). The adjusted OR for depressive symptoms in female patients was 0.365 (95% CI: 0.171-0.779, P = 0.009) compared with male patients. Depressive symptoms at baseline (OR = 4.539, 95% CI: 1.973-10.445, P < 0.001) were identified as significant predictors of depressive symptoms at 12 months. CONCLUSION There was a slight decrease in the prevalence of comorbid depressive symptoms in PWNDE over the 12-month period after epilepsy diagnosis. Cognitive impairment and baseline depressive symptoms were independent risk factors for comorbid depressive symptoms at 12 months.
Collapse
Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qingling Chen
- Department of Hepatology, Tianjin Medical University, Tianjin Second People's Hospital, Tianjin, China
| | - Mengmeng Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yingxue Lu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qian Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
13
|
Strickland JC, Jackson H, Schlienz NJ, Salpekar JA, Martin EL, Munson J, Bonn-Miller MO, Vandrey R. Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy. Epilepsy Behav 2021; 122:108205. [PMID: 34311183 DOI: 10.1016/j.yebeh.2021.108205] [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: 05/01/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 12/21/2022]
Abstract
Recent approval of Epidiolex® (pharmaceutical cannabidiol/CBD) for the treatment of Lennox Gastaut syndrome (LGS) and Dravet syndrome highlights a therapeutic efficacy of CBD in the treatment of epilepsy. However, a large number of patients with epilepsy elect to use alternative artisanal CBD products due to cost or access constraints. Despite widespread availability and variety of these artisanal CBD products, studies evaluating their safety or efficacy are rare, making conclusions about clinical utility uncertain. The purpose of the present study was to evaluate cross-sectional and longitudinal associations of artisanal CBD product use with quality of life, mental health, healthcare utilization, and epilepsy-specific outcomes within a large, observational cohort of people with epilepsy. Participants who reported using artisanal CBD products at baseline (Artisanal CBD Users; n = 280) and participants who used no cannabis-based products (Controls; n = 138) completed web-based assessments evaluating psychiatric symptoms, healthcare utilization, and epilepsy-specific factors. Follow-up surveys were collected in a subset of participants (n = 190) following baseline assessment for longitudinal comparison. Cross-sectionally, higher quality of life, lower psychiatric symptom severity, and improved sleep were observed among Artisanal CBD Users at baseline compared with Controls. Initiation of artisanal CBD product use was also related to improved health outcomes longitudinally. No group differences were observed for seizure control, but both groups included a high number of individuals with no past month seizures. Artisanal CBD Users reported significantly better epilepsy medication tolerability, use of fewer prescription medications overall, and reduced healthcare utilization compared with Controls. These findings are consistent with research indicating that practitioners recommending CBD in clinical care for epilepsy report integrating the use of CBD both as a means to improve patient quality of life as well as for seizure control.
Collapse
Affiliation(s)
- Justin C Strickland
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA.
| | - Heather Jackson
- Realm of Caring Foundation, PO Box 15224, Colorado Springs, CO, USA
| | | | - Jay A Salpekar
- Johns Hopkins University School of Medicine, Kennedy Krieger Institute, Departments of Psychiatry and Neurology, Baltimore, MD, USA
| | - Erin L Martin
- Medical University of South Carolina, Department of Neuroscience, Charleston, SC, USA
| | - Joel Munson
- Realm of Caring Foundation, PO Box 15224, Colorado Springs, CO, USA
| | | | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| |
Collapse
|
14
|
Zhong R, Chen Q, Li N, Zhang X, Lin W. Sex-based differences in the prevalence of and risk factors for depression in adult patients with epilepsy in Northeast China. Epilepsy Behav 2021; 122:108201. [PMID: 34273741 DOI: 10.1016/j.yebeh.2021.108201] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To confirm whether the prevalence of depression in patients with epilepsy (PWE) is different between the sexes, whether risk factors for depression vary between the sexes, and whether the association between cognitive function and depression in PWE is influenced by patient sex. METHODS A cohort of consecutive PWE from the First Hospital of Jilin University (Changchun, China) was recruited. Depressive symptoms were evaluated using the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy scale, and multivariate logistic regression analyses were used to identify independent risk factors for depression in both male and female PWE. RESULTS Female PWE experienced more serious depressive symptoms (p = 0.001) than male PWE. Risk factors affecting comorbid depression varied according to sex. Among male PWE, per capita monthly family income (odds ratio [OR] 0.515 [95% confidence interval (CI) 0.311-0.851]; P = 0.01), seizure frequency over the past year (OR 1.586 [95% CI 1.019-2.468], P = 0.041), polytherapy (OR 0.446 [95% CI 0.214-0.931]; P = 0.032), and Montreal Cognitive Assessment (MoCA) scale score (OR 0.926 [95% CI 0.873-0.982]; P = 0.011) were independent risk factors for depression. Among female PWE, educational level (OR 0.604 [95% CI 0.364-1]; P = 0.05) and MoCA scale score (OR 0.921 [95% CI 0.859-0.987]; P = 0.02) were independent risk factors for depression. CONCLUSION Depression was a common psychiatric comorbidity among PWE, and the prevalence of and risk factors for depression differed between males and females.
Collapse
Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qingling Chen
- Department of Hepatology, Tianjin Medical University, Tianjin Second People's Hospital, Tianjin, China
| | - Nan Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
15
|
Spruill TM, Friedman D, Diaz L, Butler MJ, Goldfeld KS, O'Kula S, Montesdeoca J, Payano L, Shallcross AJ, Kaur K, Tau M, Vazquez B, Jongeling A, Ogedegbe G, Devinsky O. Telephone-based depression self-management in Hispanic adults with epilepsy: a pilot randomized controlled trial. Transl Behav Med 2021; 11:1451-1460. [PMID: 33963873 PMCID: PMC8320882 DOI: 10.1093/tbm/ibab045] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Depression is associated with adverse outcomes in epilepsy but is undertreated in this population. Project UPLIFT, a telephone-based depression self-management program, was developed for adults with epilepsy and has been shown to reduce depressive symptoms in English-speaking patients. There remains an unmet need for accessible mental health programs for Hispanic adults with epilepsy. The purpose of this study was to evaluate the feasibility, acceptability, and effects on depressive symptoms of a culturally adapted version of UPLIFT for the Hispanic community. Hispanic patients with elevated depressive symptoms (n = 72) were enrolled from epilepsy clinics in New York City and randomized to UPLIFT or usual care. UPLIFT was delivered in English or Spanish to small groups in eight weekly telephone sessions. Feasibility was assessed by recruitment, retention, and adherence rates and acceptability was assessed by self-reported satisfaction with the intervention. Depressive symptoms (PHQ-9 scores) were compared between study arms over 12 months. The mean age was 43.3±11.3, 71% of participants were female and 67% were primary Spanish speakers. Recruitment (76% consent rate) and retention rates (86–93%) were high. UPLIFT participants completed a median of six out of eight sessions and satisfaction ratings were high, but rates of long-term practice were low. Rates of clinically significant depressive symptoms (PHQ-9 ≥5) were lower in UPLIFT versus usual care throughout follow-up (63% vs. 72%, 8 weeks; 40% vs. 70%, 6 months; 47% vs. 70%, 12 months). Multivariable-adjusted regressions demonstrated statistically significant differences at 6 months (OR = 0.24, 95% CI, 0.06–0.93), which were slightly reduced at 12 months (OR = 0.30, 95% CI, 0.08–1.16). Results suggest that UPLIFT is feasible and acceptable among Hispanic adults with epilepsy and demonstrate promising effects on depressive symptoms. Larger trials in geographically diverse samples are warranted.
Collapse
Affiliation(s)
- Tanya M Spruill
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel Friedman
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Laura Diaz
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark J Butler
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.,Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Keith S Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Susanna O'Kula
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | | | - Leydi Payano
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Amanda J Shallcross
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Kiranjot Kaur
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael Tau
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Blanca Vazquez
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Amy Jongeling
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Gbenga Ogedegbe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.,Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Orrin Devinsky
- Department of Neurology, NYU Langone Health, New York, NY, USA
| |
Collapse
|
16
|
Bennett SD, Au C, Byford S, Chorpita B, Coughtrey AE, Cross JH, Dalrymple E, Fonagy P, Ford T, Heyman I, Lewins A, Moss-Morris R, Reilly C, Xu L, Shafran R. Feasibility of telephone-delivered therapy for common mental health difficulties embedded in pediatric epilepsy clinics. Epilepsy Behav 2021; 116:107743. [PMID: 33556861 DOI: 10.1016/j.yebeh.2020.107743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mental and physical health treatment should be delivered together for children and young people with epilepsy. Training healthcare professionals (HCPs) in epilepsy services to deliver mental health interventions is an important way to facilitate integrated care. OBJECTIVE To determine the feasibility of remotely delivered assessment and psychological treatment for mental health difficulties delivered by HCPs in pediatric epilepsy clinics with limited formal training in psychological interventions. We hypothesized that it would be (i) feasible to train HCPs to deliver the psychological intervention and (ii) that participants receiving the psychological therapy would report reductions in symptoms of mental health difficulties including anxiety, depression, and behavior difficulties and improve quality of life. METHODS Thirty-four children and young people with epilepsy who had impairing symptoms of a common mental health difficulty (anxiety, depression, disruptive behavior, and/or trauma) were allocated to receive 6 months of a modular cognitive behavioral intervention delivered by a HCP with limited formal psychological therapy experience. Thirteen HCPs were trained in delivery of the intervention. Healthcare professional competence was assessed in a two-stage process. Parent-reported measures of mental health symptoms and quality of life were completed at baseline and following the intervention. Paired t-tests were used to analyze changes in symptoms over time. RESULTS All thirteen HCPs who participated in the training were considered competent in therapeutic delivery by the end of the training period. Twenty-three patients completed pre- and post-intervention measures and were included in the analysis. There were statistically significant improvements in: symptoms of mental health problems (p = 0.01; Cohen's d = 0.62), total impact of mental health problems (p = 0.03; Cohen's d = 0.52), anxiety and depression symptoms (p = 0.02; Cohen's d = 0.57) and quality of life (p = 0.01; Cohen's d = 0.57). CONCLUSION A modular cognitive behavioral treatment delivered over the telephone by HCPs with limited experience of psychological therapy was feasible and effective in treating mental health problems in children and young people with epilepsy. Health-related Quality of Life also improved over the duration of treatment. A randomized controlled trial (RCT) is needed to demonstrate efficacy of the intervention.
Collapse
Affiliation(s)
- Sophie D Bennett
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK.
| | - Christy Au
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Sarah Byford
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Bruce Chorpita
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Anna E Coughtrey
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - J Helen Cross
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Emma Dalrymple
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Peter Fonagy
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Tamsin Ford
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Amy Lewins
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Rona Moss-Morris
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Colin Reilly
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Laila Xu
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Roz Shafran
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| |
Collapse
|
17
|
A Review on Potential Footprints of Ferulic Acid for Treatment of Neurological Disorders. Neurochem Res 2021; 46:1043-1057. [PMID: 33547615 DOI: 10.1007/s11064-021-03257-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Abstract
Ferulic acid is being screened in preclinical settings to combat various neurological disorders. It is a naturally occurring dietary flavonoid commonly found in grains, fruits, and vegetables such as rice, wheat, oats, tomatoes, sweet corn etc., which exhibits protective effects against a number of neurological diseases such as epilepsy, depression, ischemia-reperfusion injury, Alzheimer's disease, and Parkinson's disease. Ferulic acid prevents and treats different neurological diseases pertaining to its potent anti-oxidative and anti-inflammatory effects, beside modulating unique neuro-signaling pathways. It stays in the bloodstream for longer periods than other dietary polyphenols and antioxidants and easily crosses blood brain barrier. The use of novel drug delivery systems such as solid-lipid nanoparticles (SLNs) or its salt forms (sodium ferulate, ethyl ferulate, and isopentyl ferulate) further enhance its bioavailability and cerebral penetration. Based on reported studies, ferulic acid appears to be a promising molecule for treatment of neurological disorders; however, more preclinical (in vitro and in vivo) mechanism-based studies should be planned and conceived followed by its testing in clinical settings.
Collapse
|
18
|
Monaghan R, O’Dwyer M, Luus R, Mulryan N, McCallion P, McCarron M, Henman MC. Antiepileptic drugs, occurrence of seizures and effect of co‐administration of potential seizure threshold‐lowering psychotropic drugs in adults with intellectual disability who have epilepsy. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:818-829. [DOI: 10.1111/jar.12857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemary Monaghan
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland
- The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS‐TILDA) School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
| | - Máire O’Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland
| | - Retha Luus
- Trinity Centre for Ageing and Intellectual Disability School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
| | - Niamh Mulryan
- The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS‐TILDA) School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
- Daughters of CharityDisability Support Services Ireland
| | - Philip McCallion
- School of Social Work College of Public Health Temple University Philadelphia PA USA
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual Disability School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
| | - Martin C. Henman
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland
| |
Collapse
|
19
|
Rashid H, Katyal J, Sood M, Tripathi M. Depression in persons with epilepsy: A comparative study of different tools in Indian population. Epilepsy Behav 2021; 115:107633. [PMID: 33309426 DOI: 10.1016/j.yebeh.2020.107633] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Depression is an important co-morbidity in persons with epilepsy (PWE) and its timely identification is essential. The aim of the study was to assess and compare the psychometric properties of potentially suitable screening tools of depression in PWE in a tertiary care setting in India. METHODS After ethical clearance, 449 PWE above 18 years of age, on anti-seizure drugs (ASDs), attending epilepsy clinic in neurology outpatient department (OPD) of All India Institute of Medical Sciences, New Delhi, India, were recruited and evaluated for depression using different tools namely: Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Patient Health Questionnaire (PHQ-9) and Hamilton Depression Rating Scale (HAM-D). Mini International Neuropsychiatric Interview (MINI: Module A, version 6.0.0) was used as reference standard. The association if any of depression with PWE variables was also determined. RESULTS A variable percentage of PWE were positive for depression- 40.1% with MINI, 40.5% with NDDI-E, 44.3% with HAM-D and 45.4% with PHQ-9. Suicidal ideation was present in 4.5% of PWE. The sensitivity and specificity of scales using MINI as a reference standard were found to be maximal at scores ≥5, ≥8 and >11 for PHQ-9, HAM-D, and NDDI-E, respectively. The ROC analysis revealed a statistically significant difference among NDDI-E and PHQ-9 (p = 0.0268). Polytherapy in PWE had significant association with risk of depression (p < 0.01) and female PWE had 1.5 times the odds of depression as compared with males (95% CI, 1.02-2.2). CONCLUSION All the tools used in this study were found to be appropriate for use in PWE if cut-off points are validated. The choice of tool can be based on the clinical setting.
Collapse
Affiliation(s)
- Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
20
|
Zhong R, Chen Q, Li M, Li N, Chu C, Li J, Zhang X, Lin W. A cross-sectional study on the association of serum uric acid levels with depressive and anxiety symptoms in people with epilepsy. BMC Psychiatry 2021; 21:17. [PMID: 33413258 PMCID: PMC7791969 DOI: 10.1186/s12888-020-03019-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND High serum uric acid (SUA) levels may provide protection against depression and anxiety through its defensive role in oxidative damage. The aim of this study was to test the hypothesis of the independent associations of lower SUA levels with depressive and anxiety symptoms among patients with epilepsy (PWE). METHODS A cross-sectional study was performed among 320 PWE aged ≥18 years old in Northeast China. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E; Chinese version) and the Generalized Anxiety Disorder-7 scale (GAD-7; Chinese version) were used as screening tools for depressive and anxiety symptoms for PWE. Serum uric acid levels were measured. The associations of SUA levels with depressive and anxiety symptoms were assessed by using binary logistic regression models, with adjustment for the related risk factors (P< 0.05). RESULTS Lower SUA tertiles were significantly associated with higher C-NDDI-E and GAD-7 scores compared with the higher two tertiles (p=0.001, and p= 0.002). Patients with depressive symptoms exhibited significantly lower SUA levels compared to those without depressive symptoms (p< 0.001). SUA levels of patients with anxiety symptoms were significantly lower than those of patients without anxiety symptoms (p< 0.001). The first and second SUA tertiles were associated with depressive symptoms, with the third tertile group as the reference group, after adjusting for confounders (first tertile: OR = 4.694, 95% CI = 1.643~ 13.413, P = 0.004; second tertile: OR = 3.440, 95% CI = 1.278~9.256, P = 0.014). However, The first and second SUA tertiles were not associated with the risk of anxiety symptoms compared with the third tertile in the adjusted logistic regression model (First tertile: OR = 1.556, 95% CI = 0.699~3.464, P = 0.279; second tertile: OR = 1.265, 95% CI = 0.607~2.635, P = 0.530). CONCLUSION We found that lower SUA levels were independently associated with depressive symptoms but not with anxiety symptoms among PWE. Further well-designed prospective cohort studies are required to determine the causality of the associations and to further clarify the mechanisms of SUA in depressive symptoms.
Collapse
Affiliation(s)
- Rui Zhong
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Qingling Chen
- grid.265021.20000 0000 9792 1228Department of Hepatology, Tianjin Medical University, Tianjin Second People’s Hospital, Tianjin, China
| | - Mengmeng Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Nan Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Chaojia Chu
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Jing Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Xinyue Zhang
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, China.
| |
Collapse
|
21
|
Operto FF, Matricardi S, Pastorino GMG, Verrotti A, Coppola G. The Ketogenic Diet for the Treatment of Mood Disorders in Comorbidity With Epilepsy in Children and Adolescents. Front Pharmacol 2020; 11:578396. [PMID: 33381032 PMCID: PMC7768824 DOI: 10.3389/fphar.2020.578396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
The ketogenic diet, used for over a century as an alternative therapy for the control of drug-resistant seizures in both children and adults, has recently drawn increasing interest in various neurological or psychiatric disorders other than epilepsy. In particular, there are a few preliminary studies in mood and neurodevelopmental disorders such as anxiety, depression and autism spectrum disorders. Mood disorders in comorbidity with epilepsy are commonly seen in adolescents and young adults both at the onset and during the course of the epileptic disorder. The rationale for the use of the ketogenic diet is based on the potential mood stabilizing effects through level modifications of metabolites such as dopamine and serotonin and the regulation of GABA/glutamatergic neurotransmission, mitochondrial function and oxidative stress. In this review, epilepsies with a higher risk of mood disorders in adolescents will be considered. A brief overview of the various types of ketogenic diet that can currently be offered to young patients in order to improve palatability and compliance with the diet, is also included. The efficacy and tolerability of the ketogenic diet options for the treatment of mood disorders, with or without drug therapy including mood stabilizers and antidepressant drugs, are as well discussed.
Collapse
Affiliation(s)
- Francesca Felicia Operto
- Department of Medicine, Surgery, and Odontoiatry, Child and Adolescent Neuropsychiatry, University of Salerno, Salerno, Italy
| | - Sara Matricardi
- Department of Child Neuropsychiatry, Children's Hospital "G. Salesi," Ospedali Riuniti Ancona, Ancona, Italy
| | - Grazia Maria Giovanna Pastorino
- Department of Medicine, Surgery, and Odontoiatry, Child and Adolescent Neuropsychiatry, University of Salerno, Salerno, Italy
| | | | - Giangennaro Coppola
- Department of Medicine, Surgery, and Odontoiatry, Child and Adolescent Neuropsychiatry, University of Salerno, Salerno, Italy
| |
Collapse
|
22
|
Abstract
Pediatric epilepsy is a highly variable condition due to age-related expression of syndromes that require specific diagnosis, evaluations, and treatments. Children with epilepsy differ from their adult counterparts in many important ways, mostly related to the age-related expression of specific epilepsy syndromes. This results in many important considerations related to the epilepsy diagnosis, classification, evaluations to determine an etiology, as well as treatment guidelines. A good understanding of these factors will help to establish an accurate epilepsy diagnosis, which in turn will guide appropriate testing and treatment decisions. In this way, patients will have improved seizure outcomes, and families will be educated appropriately and provided with the most accurate prognostic information available. The purpose of this article is to review the diagnosis, work-up, and management of pediatric epilepsy.
Collapse
Affiliation(s)
- Jeffrey R Tenney
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
23
|
Serrano burneo DC, Bowden SC, Simpson LC. Incremental Validity of the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI‐2) Relative to the Beck Depression Inventory‐Second Edition (BDI‐II) in the Detection of Depressive Symptoms. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniela C. Serrano burneo
- Centre for Clinical Neurosciences & Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Australia,
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia,
| | - Stephen C. Bowden
- Centre for Clinical Neurosciences & Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Australia,
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia,
| | - Leonie C. Simpson
- Centre for Clinical Neurosciences & Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Australia,
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia,
| |
Collapse
|
24
|
O'Dwyer R. Epilepsy: Workup and Management in Adults. Semin Neurol 2020; 40:624-637. [PMID: 33176373 DOI: 10.1055/s-0040-1719069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
When managing epilepsy, there is a temptation to focus care with respect to the last and the next seizure. However, epilepsy is a multifaceted chronic condition and should be treated as such. Epilepsy comes with many physical risks, psychological effects, and socioeconomic ramifications, demanding a long-term commitment from the treating physician. Patients with epilepsy, compared to other chronically ill patient populations, have a worse quality of life, family function, and less social support. The majority of patients are well controlled on antiseizure drugs. However, approximately one-third will continue to have seizures despite optimized medical management. The primary aim of this article is to explore the long-term management of chronic epilepsy, and to address some of the particular needs of patients with chronic epilepsy.
Collapse
Affiliation(s)
- Rebecca O'Dwyer
- Department of Neurological Science, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
25
|
A Psychosomatic Approach to Quality of Life in Patients with Epilepsy. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.778315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
26
|
Abstract
Topics for DTB review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.
Collapse
Affiliation(s)
- Donald Peter Craig
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Curtis Osborne
- Academic Clinical Fellow in Old Age Psychiatry, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
27
|
Pathways to quality of life in adolescents with genetic generalized epilepsy: The role of seizure features and affective symptoms. Epilepsy Behav 2020; 109:107115. [PMID: 32438120 DOI: 10.1016/j.yebeh.2020.107115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/22/2022]
Abstract
Both clinical features of seizures and affective problems (i.e., depressive and/or anxious symptoms) affect quality of life perception in patients with epilepsy. Although genetic generalized epilepsies (GGEs) represent one-third of all epilepsies, very few studies focused on the association among seizures, affective problems, and perceived quality of life in pediatric patients with GGE. Here, we assessed the relative contributions of seizure characteristics and affective symptoms on quality of life in patients with adolescence-onset GGE. Forty pediatric outpatients completed self-report questionnaires on affective symptoms and quality of life. Sociodemographic and clinical variables were obtained from medical charts. Affective symptoms were present in 40% of patients. Higher scores emerged in patients who were seizure-free at the time of the survey for both the physical and mental components of quality of life. Higher seizure frequency was significantly associated with lower quality of life scores in the mental component, whereas the presence of depressive and/or anxious symptoms was significantly associated with lower scores in the physical component. These associations were confirmed after controlling for sociodemographic confounders. These findings suggest that adolescents with GGE are at increased risk for affective symptoms. Moreover, both GGE-related clinical features (i.e., seizure frequency) and the presence of affective symptoms (i.e., depression, anxiety) are relevant and independent contributors to quality of life. The investigation of affective problems is warranted to be included in routine assessments of GGE in pediatric populations.
Collapse
|
28
|
Morningstar M, Hung A, Mattson WI, Gedela S, Ostendorf AP, Nelson EE. Internalizing symptoms in intractable pediatric epilepsy: Structural and functional brain correlates. Epilepsy Behav 2020; 103:106845. [PMID: 31882324 DOI: 10.1016/j.yebeh.2019.106845] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 01/09/2023]
Abstract
Internalizing disorders (i.e., depression and anxiety) are common comorbidities in people with epilepsy. In adults with epilepsy, comorbid depression or anxiety is associated with worse seizure control and reduced quality of life, and may be linked to specific neural biomarkers. Less is known about brain correlates of internalizing symptoms in pediatric populations. In the current study, we performed a retrospective analysis of 45 youth between the ages of 6 and 18 years old with intractable epilepsy. Individuals were evaluated for internalizing symptoms on the Child Behavior Checklist (CBCL) and underwent magnetic resonance (MR) and fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging as part of the clinical evaluation for surgical treatment of epilepsy. Forty-two percent of patients experienced clinically significant internalizing symptoms based on parent report. Compared with individuals who scored in the normal range, youth with clinical levels of internalizing problems showed overall reductions in cortex volume, as well as widespread reductions in cortical thickness and functional activation in the bilateral occipital/parietal lobe, left temporal regions, and left inferior frontal cortex on MR and PET scans. There were no group differences in amygdala or hippocampus volumes, nor other patient- or illness-related variables such as age, sex, or the type, lateralization, or duration of epilepsy. Results suggest that high rates of internalizing disorders are present in youth with refractory epilepsy. Multifocal reductions in cortical thickness and function may be nonspecific risk factors for clinically meaningful internalizing symptoms in youth with chronic epilepsy. As such, the presence of broad cortical thinning and reduced glucose uptake upon radiological examination may warrant more focused clinical evaluation of psychological symptoms.
Collapse
Affiliation(s)
- Michele Morningstar
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America.
| | - Andy Hung
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Whitney I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Satyanarayana Gedela
- Department of Pediatrics and Neurology, Emory University College of Medicine, Atlanta, GA, United States of America
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Eric E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
| |
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW For patients living with epilepsy, quality of life is determined not only by seizure control but by mood, antiepileptic drug adverse effects, relationships, and access to education, employment, and transportation. This article reviews some of the most commonly encountered concerns associated with epilepsy, including mood disorders, driving, injuries, mortality, bone health, genetic burden, and impact on relationships. RECENT FINDINGS People with epilepsy are at increased risk for anxiety, depression, and suicide. Depression is underrecognized in patients with epilepsy, but effective validated screening tools are available for use. Mortality rates for people with epilepsy are 2 times higher than those of the general population, but much of this is attributable to underlying conditions rather than seizures. Sudden unexpected death in epilepsy (SUDEP) occurs in an estimated 1:1000 adults with epilepsy per year, and the risk can be reduced by improved observation and seizure control. An increased risk of injury, including fractures, is also present in patients with epilepsy. Reduced bone health leading to increased fracture risk is an important negative consequence of long-term use of antiepileptic medication. Seizures while driving can also cause accidents and injury. Despite the importance of driving for people with epilepsy, physicians are underperforming in providing counsel about driving. SUMMARY Optimal care of the patient with epilepsy includes addressing risks to emotional health, physical health including fractures and SUDEP, social health, and an independent lifestyle. Identification of and treatments to reduce these risks can do more to improve quality of life than a narrow clinical focus on seizure control alone.
Collapse
|
30
|
Kobau R, Manderscheid R, Owens S, LaFrance WC, Sajatovic M. Bridging the divide between epilepsy and mental health to drive solutions. Epilepsy Behav 2019; 101:106576. [PMID: 31706920 PMCID: PMC8466722 DOI: 10.1016/j.yebeh.2019.106576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 12/19/2022]
Abstract
Since its establishment in 2000, Epilepsy & Behavior has published more than 1000 papers on mental health issues among people with epilepsy, including about 200 reviews. These studies on prevalence, treatment, and guidance for future research are important contributions to the field, and they offer great promise. Yet these papers and the multitude published in other journals over the years have failed to result in systematic, scaled changes in how the epilepsy field in the United States addresses mental health issues. The mental health assessment and management gap is especially notable given decades-old, as well as more recent, recommendations from national initiatives on epilepsy, consensus statements, and other expert appeals to reduce psychiatric burden. Selected or comprehensive elements of emerging models and latest approaches from behavioral health (e.g., peer support) and public health (e.g., community-clinical linkages) highlight current opportunities to engage multiple community partners and sectors to bridge the epilepsy and behavioral health fields to implement solutions for improved mental healthcare for people with epilepsy. In honor of the 20th anniversary of Epilepsy & Behavior and its contribution to the literature and the field, we seek to build public health roadmaps to bridge the epilepsy and behavioral health divide-with new epilepsy partners who can expand community-based partnerships that may help facilitate systematic changes to close mental health treatment gaps. Special Issue: Epilepsy & Behavior's 20th Anniversary.
Collapse
Affiliation(s)
- Rosemarie Kobau
- Epilepsy Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Mail Stop MS107-6, 4770 Buford Hwy, 30341, GA, United States.
| | - Ron Manderscheid
- National Association of County and Behavioral Health and Developmental Disability Directors and the National Association for Rural Mental Health, United States
| | - Steven Owens
- Epilepsy Foundation, 8301 Professional Place West, Suite 200, Landover, MD 20785, United States
| | - W Curt LaFrance
- Rhode Island Hospital, Brown University, Departments of Psychiatry and Neurology, 593 Eddy Street, Providence, RI 02903, United States
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44016, United States
| |
Collapse
|
31
|
Jones JE. Editorial on "Current behavioral health screening practices in pediatric epilepsy, by Wagner et al. (this issue)". Epilepsy Behav 2019; 101:106221. [PMID: 31113758 DOI: 10.1016/j.yebeh.2019.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/16/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Jana E Jones
- Matthews Neuropsychology Section, Department of Neurology, University of Wisconsin School of Medicine & Public Health, United States of America
| |
Collapse
|
32
|
Wagner JL, Modi AC, Guilfoyle SM, Junger KF, Weyand C, Smith G, Griffin M, Mucci G. Current behavioral health and cognitive screening practices in pediatric epilepsy. Epilepsy Behav 2019; 101:106214. [PMID: 31680024 DOI: 10.1016/j.yebeh.2019.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Initiatives such as the Epilepsy Learning Healthcare System continue to advocate for standardized care and shared outcome data. Therefore, the current project aim was to gather information from epilepsy healthcare professionals, behavioral health professionals in particular, regarding their behavioral health and cognitive screening practices in pediatric patients with epilepsy. Information obtained will be used to assist in the development of new educational programs and platforms in the American Epilepsy Society (AES) and to inform the development of guidelines for behavioral healthcare of patients with pediatric epilepsy. SURVEY INFORMATION Twenty-five AES members representing 25 unique epilepsy programs across the United States participated in the survey. Findings are described in terms of three focus areas: (1) Systems, (2) Assessment, and (3) Intervention. Over 80% of respondents surveyed reported that they do conduct formal screenings, most commonly to determine if further evaluation is indicated (81%), inform treatment decisions (57.1%), and for developmental surveillance (33.3%). Assessment methods were fairly evenly split between nonstandardized informal questions (50%) and evidence-based broadband measures, with the Behavior Assessment System for Children (BASC), 2nd or 3rd Editions (40%) most commonly used. If behavioral health concerns are identified, referrals are often made for psychotherapy (48% in-house; 80% community-based), psychiatry (68% in-house; 48% community-based), and cognitive testing (88% neuropsychological testing; 36% for psychoeducational testing). Thirty-two percent refer for psychotropic medication management. CONCLUSION According to this survey, a number of epilepsy centers and clinics incorporate behavioral health screening; however, there is significant variability in assessments/measures used, who is administering them, and their purpose in the trajectory of treatment. These findings emphasize the need for standardization across centers in order to most effectively provide comprehensive care for youth with epilepsy.
Collapse
Affiliation(s)
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Shanna M Guilfoyle
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Katherine F Junger
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | - Gigi Smith
- Medical University of South Carolina, Charleston, SC, USA
| | - Millie Griffin
- Medical University of South Carolina, Charleston, SC, USA
| | - Grace Mucci
- Children's Hospital of Orange County, Orange, CA, USA
| |
Collapse
|
33
|
Zheng Y, Ding X, Guo Y, Chen Q, Wang W, Zheng Y, Wang S, Ding Y, Ding M. Multidisciplinary management improves anxiety, depression, medication adherence, and quality of life among patients with epilepsy in eastern China: A prospective study. Epilepsy Behav 2019; 100:106400. [PMID: 31634729 DOI: 10.1016/j.yebeh.2019.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of a multidisciplinary program on anxiety, depression, medication adherence, and quality of life in patients with epilepsy in eastern China. METHODS A cohort of 184 patients with epilepsy from the epilepsy clinic of a tertiary hospital in eastern China completed this program, out of which 92 were randomized into the intervention group and 92 the control group. Patients in both groups received standard antiepileptic drugs (AEDs), while those of the intervention group received an additional 12-month multidisciplinary program developed by a group of the epileptologist, pharmacist, psychiatrist, and epilepsy specialist nurse. Patients were assessed both before and after the 12-month period. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the eight-item Morisky Medication Adherence Scale (MMAS-8) were used to assess the severity of depression, anxiety, and medication adherence, respectively, along with Quality of life in Epilepsy-31 (QOLIE-31) and self-reported seizure frequency for life quality and seizure severity. RESULTS The 12-month multidisciplinary program significantly reduced the number of patients with severe depression (p = 0.013) and anxiety (p = 0.002), increased the number of patients with moderate-to-high AED adherence (p = 0.006) and the overall QOLIE-31 score (p < 0.001) in the intervention group. Both groups demonstrated a significant increase in the number of patients with a low seizure frequency after the 12-month period (p < 0.001). CONCLUSION The 12-month multidisciplinary program offers an effective management strategy in improving psychiatric comorbidities, medication adherence, and quality of life in patients with epilepsy in eastern China.
Collapse
Affiliation(s)
- Yang Zheng
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Xiaoyan Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yi Guo
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China.
| | - Qiaozhen Chen
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Weijun Wang
- Department of Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yuanyuan Zheng
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Shan Wang
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Meiping Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| |
Collapse
|
34
|
Dunn DW. Should pediatric neurologists play a role in the management of the most common psychiatric comorbidities in children with epilepsy? Practical considerations. Epilepsy Behav 2019; 98:314-317. [PMID: 30558862 DOI: 10.1016/j.yebeh.2018.11.013] [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: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
Child neurologists should provide initial care for the mental health problems of children and adolescents with epilepsy. Attention deficit hyperactivity disorder (ADHD), autism spectrum disorders are common comorbidities of childhood epilepsy. The psychotropic drugs used to treat mental health disorders can be safely employed in children with seizures. Child neurologists can diagnose common behavioral problems, should be comfortable with first-line agents to treat common psychiatric illnesses, and should recognize when support from psychologists or child and adolescent psychiatrists is needed. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
Collapse
Affiliation(s)
- David W Dunn
- Departments of Psychiatry and Neurology, Indiana University School of Medicine, 705 Riley Hospital Drive, ROC 4300, Indianapolis, IN 46202, United States of America.
| |
Collapse
|
35
|
Munger Clary HM, Salpekar JA. Should adult neurologists play a role in the management of the most common psychiatric comorbidities? Practical considerations. Epilepsy Behav 2019; 98:309-313. [PMID: 30471892 PMCID: PMC6614011 DOI: 10.1016/j.yebeh.2018.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 11/17/2022]
Abstract
Despite the high prevalence and negative impact of psychiatric comorbidities on the life of adults with epilepsy, significant unmet mental health care need exists because of a variety of factors, including poor access to mental health care providers. A potential solution to address access barriers is neurologist-driven diagnosis and management of common psychiatric conditions in epilepsy, of which mood and anxiety disorders are the most common. In this manuscript, patient selection criteria and practical treatment strategies are outlined for common mood and anxiety disorders that can be safely managed by neurologists. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
Collapse
Affiliation(s)
- Heidi M Munger Clary
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America.
| | - Jay A Salpekar
- Departments of Psychiatry and Neurology, Johns Hopkins University, Baltimore, MD, United States of America
| |
Collapse
|
36
|
The effect of duloxetine on ECoG activity of absence-epilepsy model in WAG/Rij rats. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.595608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
37
|
Le Marne FA, Towns SJ, Gaskin C, Ho J, Baker R, Beavis E, Bye AM. Implementing a new adolescent epilepsy service: Improving patient experience and readiness for transition. J Paediatr Child Health 2019; 55:819-825. [PMID: 30474164 DOI: 10.1111/jpc.14301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/21/2018] [Accepted: 10/14/2018] [Indexed: 11/30/2022]
Abstract
AIM To implement and appraise a new model of care in terms of: patient experience, knowledge of epilepsy, readiness for transition and emotional and behavioural support in a new purpose-built facility for adolescents and young adults. METHODS The new model of care included: upskilling of neurology staff in adolescent engagement and provision of group education sessions on epilepsy and mental health (MH), along with MH support, in a new purpose-built adolescent facility. Parameters examined pre- and post-attendance at the new clinic included: adolescent experience of service delivery, transition readiness, emotional and behavioural well-being, epilepsy knowledge and medication adherence. RESULTS A total of 45 adolescents (mean age 15.7 years) attended the new epilepsy clinic between February 2017 and December 2017. Adolescents felt significantly better informed following education in relation to epilepsy and driving, alcohol/street drugs and birth control/pregnancy. There was no significant improvement in self-reported medication adherence, transition readiness or mental well-being at follow-up. While MH education was ranked highly in terms of importance by adolescents and parents at baseline, attendance at MH education and engagement with MH support was low. CONCLUSIONS This paper documents what is important to young people with epilepsy regarding service delivery. The new adolescent service was well received. Based on feedback from adolescents and parents relating to the service, and the suboptimal uptake of MH supports, the model of care has been revised to reduce attendance burden on families and improve patient experience.
Collapse
Affiliation(s)
- Fleur A Le Marne
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan J Towns
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Claire Gaskin
- Consultation-Liaison Psychiatry, Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Faculty of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane Ho
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Baker
- Consultation-Liaison Psychiatry, Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Anne M Bye
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
38
|
Henning O, Landmark CJ, Henning D, Nakken KO, Lossius MI. Challenges in epilepsy-The perspective of Norwegian epilepsy patients. Acta Neurol Scand 2019; 140:40-47. [PMID: 30963535 DOI: 10.1111/ane.13098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES For most people with epilepsy (PWE), problems that are not directly related to seizures may constitute major challenges in everyday life. The purpose of this study was to determine the extent of these challenges and any risk factors for their occurrence among PWE in Norway, based on the patients' own perspective. MATERIALS AND METHODS We used a web-based survey to ask PWE visiting the homepage of the Norwegian Epilepsy Association about different everyday challenges. A link to the survey was accessible via the members' homepage for a 4-month period during 2017. RESULTS One thousand one hundred eighty-two PWE responded to the questionnaire. Although more than 40% of the cohort reported that they had been seizure free for at least 1 year, the majority reported that tiredness (71%), memory problems (70%), concentration problems (68%), headache or vertigo (51%), and feeling depressed (59%) continued to represent challenges. In addition, fear of being alone, sexual problems or difficulties in social settings were reported by about one-third of the patients. Reporting having these challenges was significantly associated with female gender, polytherapy, experiencing seizures during the previous 12 months and feeling blue or depressed. CONCLUSIONS The results of this study, reflecting a self-selected Norwegian population, provide insights into the challenges not directly associated with seizures that impact on the quality of life of PWE. The impacts of such challenges may be underestimated as components of the entire burden of epilepsy.
Collapse
Affiliation(s)
- Oliver Henning
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
| | - Cecilie J. Landmark
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
- Section for Clinical Pharmacology, Department of Pharmacology Oslo University Hospital Oslo Norway
- Programme for Pharmacy, Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - David Henning
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
| | - Karl O. Nakken
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
| | - Morten I. Lossius
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
- Medical Faculty University of Oslo Oslo Norway
| |
Collapse
|
39
|
Assessment and Management of Depression and Anxiety in Children and Adolescents with Epilepsy. Behav Neurol 2019; 2019:2571368. [PMID: 31191736 PMCID: PMC6525933 DOI: 10.1155/2019/2571368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/07/2019] [Indexed: 11/29/2022] Open
Abstract
Anxiety and depression in children and adolescents with epilepsy are common comorbidities which place a significant burden on patients and families and complicate the clinical management of epilepsy. This paper presents a narrative review on the aetiology, phenomenology, assessment, and management of depression and anxiety among paediatric patients with epilepsy. The recognition of affective comorbidity in paediatric epilepsy is limited at present, and the contributory role of antiepileptic medication towards such comorbidity must be considered by clinicians.
Collapse
|
40
|
Abstract
INTRODUCTION Depression is one of the most frequent comorbidities in epilepsy affecting between 17% and 22% of patients, but it is still underdiagnosed and undertreated. Areas covered: This paper discusses recent advances about screening, diagnosis, and treatment of depression in epilepsy taking into account the heterogeneity of clinical scenarios where depression can occur. Expert opinion: A number of screening instruments are now validated for adults with epilepsy, and their psychometric properties are discussed but the NDDI-E is the most practical and cost-effective. Challenges in diagnosing depression in epilepsy are discussed including reasons for the atypical features of mood disorders in epilepsy. Psychological treatments and/or SSRIs are indicated, but the level of evidence is still low. Even if there is no reason to hypothesise that internationally accepted guidelines of treatment of depression outside epilepsy may not be valid, rigorous studies are needed in order to have proper outcome measures. Epilepsy centers should have well-defined care pathways for depression in order to provide access to mental health support when needed.
Collapse
Affiliation(s)
- Marco Mula
- a Institute of Medical and Biomedical Education , St George's University of London and The Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust , London , UK
| |
Collapse
|
41
|
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
|
42
|
Modi AC, Gutierrez-Colina AM, Wagner JL, Smith G, Junger K, Huszti H, Mara CA. Executive functioning phenotypes in youth with epilepsy. Epilepsy Behav 2019; 90:112-118. [PMID: 30530131 DOI: 10.1016/j.yebeh.2018.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/23/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objectives of this study were to identify executive functioning (EF) phenotypes in youth with epilepsy and to examine whether phenotypes differ on psychosocial and medical outcomes (i.e., absence/presence of seizures in the past three months), health-related quality of life (HRQOL), and emotional and behavioral functioning. METHODS Youth 5-18 years with diagnosed epilepsy and caregivers completed a battery of questionnaires as part of a larger national validation of the Pediatric Quality of Life (PedsQL) Epilepsy Module. The primary measure of interest was the Behavior Rating Inventory of Executive Function-Parent Form. Medical chart reviews and demographic data were also collected. Latent class analysis was used to identify EF phenotypes. Chi-square and analyses of covariance (ANCOVA) were conducted to examine EF phenotype group differences on seizure outcomes, HRQOL, and behavioral and emotional functioning. RESULTS Two-hundred and thirty-seven children with epilepsy (Mage = 11.2 years; 56% female; 60% White: Non-Hispanic; 55% experienced seizures in the past three months) and their caregivers participated. Four EF phenotypes were identified: Group 1 - No EF deficits (45% of sample), Group 2 - Global EF deficits (29% of sample), Group 3 - Behavioral Regulation + Working Memory deficits (8% of sample), and Group 4 - Metacognitive deficits (17% of sample). No significant EF phenotype group differences were found for seizure characteristics. The ANCOVAs indicated significant EF phenotype group differences on HRQOL (parent-reported Impact, Cognitive, Sleep, EF, and Mood/Behavior and child-reported Cognitive, Sleep, EF, and Mood/Behavior subscales; ps < .001) and emotional and behavioral functioning (Externalizing, Internalizing, and Behavioral Symptom Index; ps < .001), with the Global EF deficits (Group 2) and Behavioral Regulation + Working Memory deficits groups (Group 3) demonstrating the greatest level of impairment. CONCLUSION Phenotypic variability in EF is significantly related to patient-reported outcomes. Interventions addressing EF deficits need to be individualized to a child's particular EF phenotype to achieve optimal outcomes.
Collapse
Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America.
| | - Ana M Gutierrez-Colina
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America
| | - Janelle L Wagner
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St. MSC 160, Charleston, SC 29425-1600, United States of America
| | - Gigi Smith
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St. MSC 160, Charleston, SC 29425-1600, United States of America
| | - Katherine Junger
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America
| | - Heather Huszti
- Division of Pediatric Psychology, Children's Hospital of Orange County, 1120 W La Veta Ave 470, Orange, CA 92868, United States of America
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America
| |
Collapse
|
43
|
Coppola G, Operto FF, Matricardi S, Verrotti A. Monitoring And Managing Depression In Adolescents With Epilepsy: Current Perspectives. Neuropsychiatr Dis Treat 2019; 15:2773-2780. [PMID: 31576132 PMCID: PMC6765392 DOI: 10.2147/ndt.s192714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/02/2019] [Indexed: 11/23/2022] Open
Abstract
Epilepsy is associated with a significantly increased risk of developing depressive disorder during adolescence. On the other hand, depression is highly detected in adolescents with epilepsy. These findings highlight the importance of early identification and proper management of comorbid depression in adolescent age. The prevalence of depressive disorders in adolescents with epilepsy ranges between 8 and 35% and is higher than the general population of the same age. The relationship between epilepsy and depression is complex and potentially bidirectional, thereby suggesting a common underlying pathophysiology. Furthermore, failure to detect and treat depressive disorder mostly in adolescence could lead to several negative implications such as an increased risk of suicidal ideation or behavior and poor quality of life. A number of methods are available to detect depressive disorder, such as psychiatric or psychological assessments, structured or semi-structured interviews, and self-report screening tools. Thus, physicians should be able to regularly screen depressive symptoms in youths with epilepsy. Recently, the NDDI-E-.Y inventory has been developed from the adult NDDI-E, and has been validated in many countries. NDDI-E-Y has showed reliable validity, being a brief screening tool (12 items) that can be easily included in routine epilepsy care. The first step to be considered for the management of depressive disorder in adolescents with epilepsy is to consider potential reversible causes of anxiety and depression (i.e., a new AEDs; seizure control). Secondly, great attention has to be given to the education of the child/adolescent and his/her family, trying to improve knowledge about epilepsy as well as to decrease parental stress and improving the child's sense of competence. Pharmacological treatment should also be considered in adolescents diagnosed with depression.
Collapse
Affiliation(s)
- Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Department of Medicine, Surgery, and Odontoiatry, University of Salerno, Salerno, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry, Department of Medicine, Surgery, and Odontoiatry, University of Salerno, Salerno, Italy
| | - Sara Matricardi
- Department of Pediatric Neurology, Ospedali Riuniti, Ancona, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
44
|
Baker DA, Caswell HL, Eccles FJR. Self-compassion and depression, anxiety, and resilience in adults with epilepsy. Epilepsy Behav 2019; 90:154-161. [PMID: 30557784 DOI: 10.1016/j.yebeh.2018.11.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research suggests that people with epilepsy (PWE) are more likely to experience depression and anxiety than the general population. Given the adversity associated with the condition, resilience may also be important. However, to date, resilience has been largely overlooked in the epilepsy literature. Self-compassion has been widely associated with improved psychological wellbeing and, to a lesser extent, resilience. However, the relationship between self-compassion and depression, anxiety, and resilience in PWE has not been examined. OBJECTIVES Using a quantitative cross-sectional survey design, the aim of the present study was to examine the extent to which self-compassion predicted depression, anxiety, and resilience when controlling for demographic and illness-related variables. METHODS Adults with epilepsy were invited to take part in a survey online or in epilepsy or neurology clinics. Two-hundred and seventy participants completed the survey, and data were analyzed using hierarchical multiple regression models. RESULTS In this sample of PWE, self-compassion significantly predicted lower depression and anxiety and higher resilience when other significant sociodemographic and illness-related variables had been taken into account. CONCLUSIONS The findings of the present study indicate that self-compassion could be an important factor in determining psychological outcomes for adults with epilepsy, and its role is worthy of further exploration to help improve psychological outcomes for PWE.
Collapse
Affiliation(s)
- David A Baker
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK
| | - Helen L Caswell
- Department of Clinical Neuropsychology, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK.
| |
Collapse
|
45
|
Knudsen-Baas KM, Johannesen TB, Myklebust TÅ, Aarseth JH, Owe JF, Gilhus NE, Storstein AM. Antiepileptic and psychiatric medication in a nationwide cohort of patients with glioma WHO grade II-IV. J Neurooncol 2018; 140:739-748. [PMID: 30471051 DOI: 10.1007/s11060-018-03007-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/20/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Glioma is the most common intracranial primary brain tumor. Patients with glioma often suffer from epilepsy, anxiety and depression. Aims of this study were to identify risk factors for drug-treated anxiety and depression, and to determine the use of psychiatric medication in a national glioma cohort. METHODS Data from the Cancer Registry of Norway on all persons diagnosed with glioma WHO grade II-IV 2004-2010 were linked with data from the Norwegian Prescription Database. Cox regression analysis was used to assess risk factors for drug-treated anxiety and depression. Standardized incidence ratios were calculated for psychiatric medication dispensed to glioma patients and compared to the general population. RESULTS The glioma cohort consisted of 1056 males and 772 females. Of the 1828 patients, 565 had glioma grade II-III, and 1263 had grade IV. The patients with glioma grade II-III who were treated with levetiracetam had an increased risk for drug-treated anxiety compared to patients without levetiracetam; hazard ratio 2.8 (95% confidence interval 1.7-4.9). Female gender increased the risk for drug-treated anxiety compared to males in patients with glioma grade IV; hazard ratio 1.5 (95% confidence interval 1.2-2.0). Antidepressants were less frequently dispensed to patients with glioma grade II-III and epilepsy than to the general population. CONCLUSIONS Patients with glioma grade II-III on levetiracetam had an increased risk for drug-treated anxiety. The subgroup of patients with glioma grade II-III and epilepsy received less antidepressants than the general population.
Collapse
Affiliation(s)
| | - Tom Børge Johannesen
- Department of Registration, Cancer Registry of Norway, Ullernchausseen 64, Oslo, 0379, Norway
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry of Norway, Ullernchausseen 64, Oslo, 0379, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Post Box 1600, 6026, Ålesund, Norway
| | - Jan Harald Aarseth
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Jone Furlund Owe
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Post Box 7804, 5020, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | | |
Collapse
|
46
|
Noble AJ, Reilly J, Temple J, Fisher PL. Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy: a systematic review of clinically reliable improvement. J Neurol Neurosurg Psychiatry 2018; 89:1129-1137. [PMID: 29735512 PMCID: PMC6227812 DOI: 10.1136/jnnp-2018-317997] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 11/25/2022]
Abstract
Psychological treatment is recommended for depression and anxiety in those with epilepsy. This review used standardised criteria to evaluate, for the first time, the clinical relevance of any symptom change these treatments afford patients. Databases were searched until March 2017 for relevant trials in adults. Trial quality was assessed and trial authors asked for individual participants' pre-treatment and post-treatment distress data. Jacobson's methodology determined the proportion in the different trial arms demonstrating reliable symptom change on primary and secondary outcome measures and its direction. Search yielded 580 unique articles; only eight eligible trials were identified. Individual participant data for five trials-which included 398 (85%) of the 470 participants randomised by the trials-were received. The treatments evaluated lasted ~7 hours and all incorporated cognitive-behavioural therapy (CBT). Depression was the primary outcome in all; anxiety a secondary outcome in one. On average, post-treatment assessments occurred 12 weeks following randomisation; 2 weeks after treatment had finished. There were some limitations in how trials were conducted, but overall trial quality was 'good'. Pooled risk difference indicated likelihood of reliable improvement in depression symptoms was significantly higher for those randomised to CBT. The extent of gain was though low-the depressive symptoms of most participants (66.9%) receiving CBT were 'unchanged' and 2.7% 'reliably deteriorated'. Only 30.4% made a 'reliable improvement. This compares with 10.2% of participants in the control arms who 'reliably improved' without intervention. The effect of the treatments on secondary outcome measures, including anxiety, was also low. Existing CBT treatments appear to have limited benefit for depression symptoms in epilepsy. Almost 70% of people with epilepsy do not reliably improve following CBT. Only a limited number of trials have though been conducted in this area and there remains a need for large, well-conducted trials.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - James Reilly
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - James Temple
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Nidaros DPS, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
47
|
Lee SA, Jeon JY, No SK, Park H, Kim OJ, Kwon JH, Jo KD. Factors contributing to anxiety and depressive symptoms in adults with new-onset epilepsy. Epilepsy Behav 2018; 88:325-331. [PMID: 30340902 DOI: 10.1016/j.yebeh.2018.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE We investigated factors contributing to anxiety and depressive symptoms over a 1-year period in Korean adults with new-onset epilepsy. METHODS This longitudinal multicenter study included adults diagnosed with epilepsy within 12 months of a first seizure. Using stepwise regression analyses, we determined whether Hospital Anxiety Depression Scale (HADS) scores could be predicted by demographic, clinical, and psychosocial variables at baseline and at 12 months. RESULTS Of 141 patients included at baseline, 63 (44.7%) and 60 (42.6%) had Hospital Anxiety Depression Scale-Anxiety (HADS-A) and Hospital Anxiety Depression Scale-Depression (HADS-D) scores >7, respectively. Of 98 patients who completed the 12-month study, the corresponding figures decreased to 32.7% and 36.7%, respectively. Higher HADS-A scores both at baseline and 12 months were predicted by higher neuroticism, stigma, and lower self-esteem (p < 0.05). Higher HADS-D scores at baseline were predicted by higher neuroticism, lower self-esteem, marital status, and lower extroversion (p < 0.05) whereas those at 12 months were predicted by self-esteem, seizure recurrence, and age at epilepsy onset (p < 0.05). Neuroticism or self-esteem was the strongest predictor of psychological distress. CONCLUSIONS Anxiety and depressive symptoms are common at the time of diagnosis in Korean adults with new-onset epilepsy. While these decrease over time, they remained high 12 months after epilepsy diagnosis. Psychological factors, particularly neuroticism and self-esteem, may be the most important risk factors. Epilepsy variables, such as seizure recurrence and age at onset, may also be important factors for depressed mood at 12 months.
Collapse
Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ji Ye Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon-Kee No
- Department of Neurology, Bong-Seng Memorial Hospital, Pusan, Republic of Korea
| | - Hyungkook Park
- Department of Neurology, SoonChunHyang University College of Medicine, Cheonan, Republic of Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA University, Seongnam, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan College Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kwang-Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| |
Collapse
|
48
|
Fisher PL, Reilly J, Noble A. Metacognitive beliefs and illness perceptions are associated with emotional distress in people with epilepsy. Epilepsy Behav 2018; 86:9-14. [PMID: 30036766 DOI: 10.1016/j.yebeh.2018.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/05/2018] [Accepted: 07/08/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Emotional distress is common in people with epilepsy (PWE) for which efficacious interventions are required. Developing evidence-based treatments should be based on testable models of the psychological mechanisms maintaining psychopathology. The Self-Regulatory Executive Function (S-REF) model proposes that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. Although preliminary support exists for the role of metacognitive beliefs in emotional distress in PWE, their role has yet to be tested when controlling for the contribution made by illness perceptions. METHODS Four hundred and fifty-seven PWE completed an online survey, which assessed anxiety, depression, metacognitive beliefs, illness perceptions, general demographic factors, and epilepsy characteristics. RESULTS Hierarchical regression analyses demonstrated that metacognitive beliefs and illness perceptions were both associated with anxiety and depression when controlling for the influence of demographic variables and epilepsy characteristics. However, metacognitive beliefs accounted for more variance in anxiety and depression than illness perceptions. CONCLUSION Metacognitive beliefs appear to make a greater contribution to anxiety and depression in PWE than illness perceptions. Prospective studies are now needed to establish the causal role of metacognitive beliefs in both the development and persistence of emotional distress.
Collapse
Affiliation(s)
- Peter L Fisher
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - James Reilly
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - Adam Noble
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| |
Collapse
|
49
|
Górska N, Słupski J, Cubała WJ, Wiglusz MS, Gałuszko-Węgielnik M. Antidepressants in epilepsy. Neurol Neurochir Pol 2018; 52:657-661. [PMID: 30131174 DOI: 10.1016/j.pjnns.2018.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/19/2022]
Abstract
People with epilepsy (PWE) frequently suffer from comorbid mood and anxiety disorders. Depression is one of the major psychiatric comorbidities having a negative impact on the quality of life in people with epilepsy. A review of the literature indicates that the majority of antidepressant-related seizures have been associated with either ultra-high doses or overdosing and, generally, the risk of antidepressant-associated seizures is low. Correspondingly, there is some evidence indicating that antidepressants of most widely used groups may additionally lower the risk of triggering seizures. Four antidepressants are not recommended for patients with epilepsy, i.e.: amoxapine, bupropion, clomipramine and maprotiline. Clinicians applying first line of depression treatment in patients with epilepsy should consider use of SSRIs or SNRIs, particularly sertraline, citalopram, mirtazapine, reboxetine, paroxetine, fluoxetine, escitalopram, fluvoxamine, venlafaxine, duloxetine. Implementation of anticonvulsive drugs in depressed patients should include valproate, carbamazepine, lamotrigine, gabapentin, pregabalin. The paper reviews the evidence for the clinical use of antidepressants in PWE.
Collapse
Affiliation(s)
- Natalia Górska
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Jakub Słupski
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
| | - Wiesław Jerzy Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | | |
Collapse
|
50
|
Computer-based monitoring and evaluation of epilepsy-related health variables and their impact on treatment decision. Epilepsy Behav 2018; 84:173-178. [PMID: 29724486 DOI: 10.1016/j.yebeh.2018.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/29/2018] [Accepted: 02/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of electronic patient-reported outcomes (ePROs) with focus on epilepsy-specific quality of life, psychiatric and psychosocial burden, drug side effects, and patient satisfaction via the Computer-based Health Evaluation System (CHES) and to evaluate their impact on treatment regimen. METHODS Forty consecutive patients with drug-resistant focal epilepsy undergoing prolonged video-electroencephalography (EEG) monitoring at the Department of Neurology, Innsbruck Medical University were included and randomized to an intervention group (questionnaire results accessible to the physicians) and a control group (questionnaire results inaccessible to the physicians). Patients had to complete questionnaires on the day of admission (T0) and the day of discharge (T1). RESULTS Overall, twenty-five patients (25/40, 62.5%) showed abnormal assessment results, twelve of them exclusively due to pathological scores on the Liverpool Adverse Events Profile (LAEP). Mean LAEP score was within the pathological range of 48.8 points (48.8 ± 7.2). The psychosocial burden with respect to the Performance, Socio-Demographic Aspects, Subjective Evaluation (PESOS) scale "fear" (48.7 ± 21.4) was also moderately affected. Moreover, mean anxiety (9.1 ± 4.4) and depression (7.6 ± 4.5) scores were both slightly abnormal. Quality of life (as measured using the Quality of Life Inventory in Epilepsy (QOLIE-31)) was moderately impaired (seizure worry: 46.5 ± 21.3, overall quality of life: 52.6 ± 18.6, well-being: 54.1 ± 16.3, energy-fatigue: 39.4 ± 14.7, cognitive functioning: 41.4 ± 19.5, medication effects: 46.2 ± 23.4, social functioning: 51.1 ± 20.8, and total score: 47.2 ± 12.3). Careful medical history-taking and patient-physician consultations alone failed to detect needs for psychological/psychiatric help in three out of 7 patients in the control group (42.8%). Changes over time in Hospital Anxiety and Depression Scale (HADS) and QOLIE-31 scores were not significant. CONCLUSION The use of ePROs was feasible and well accepted in the clinical setting. Treatment-associated adverse effects were the most frequently reported health-related restrictions. In particular, psychometric evaluation by applying ePROs can detect health-related problems in patients with epilepsy.
Collapse
|