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Ertan D, Mezouar N, Tarrada A, Maillard L, El-Hage W, Hingray C. Post-epileptic seizure posttraumatic stress Disorder: A mediation analysis. Epilepsy Behav 2024; 157:109863. [PMID: 38824749 DOI: 10.1016/j.yebeh.2024.109863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Previous studies investigated the varying prevalence of post-epileptic seizure posttraumatic stress disorder (PS-PTSD). The current study aimed first to compare the profiles of patients with and without PS-PTSD and, second, to study the interaction between other past traumatic experiences, subjective ictal anxiety, psychiatric comorbidities, and PS-PTSD in people with epilepsy (PWE). METHODS We conducted an observational study, investigating past traumatic experiences and PS-PTSD through standardized scales (CTQ-28, LEC-5 and PCL-5). We used semi-structured interviews and validated psychometric scales (NDDIE for depression and GAD-7 for anxiety) to collect data on general psychiatric comorbidities. We also assessed epilepsy specific psychiatric symptoms (interictal and peri-ictal). We performed a mediation analysis through PROCESS for SPSS to evaluate the effect of history of past trauma and subjective ictal anxiety on PS-PTSD through interictal depression and anxiety symptoms. RESULTS We enrolled 135 PWE, including 35 patients with PS-PTSD (29.5 %). Patients with PS-PTSD had significantly higher depression (12.87 vs 10; p = 0.005) and anxiety (7.74 vs 5.01; p = 0.027) scores and higher prevalence of peri-ictal psychiatric symptoms, compared to patients without PS-PTSD. The relationship between other past traumatic experiences and PS-PTSD was totally mediated by interictal depression and anxiety. We found a significant indirect effect of interictal anxiety symptoms on the path between subjective ictal anxiety and PS-PTSD. SIGNIFICANCE Our results showed that patients with PS-PTSD have a more severe psychopathological profile (more peri ictal and inter ictal depressive and anxiety symptoms). Both inter ictal and subjective ictal anxiety appear to have a significant role in PS-PTSD.
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Affiliation(s)
- Deniz Ertan
- Institut La Teppe Tain l'Hermitage, France; CHRU de Nancy, Département de Neurologie, Nancy, France
| | | | | | | | - Wissam El-Hage
- CHU de Tours, Tours, France; UMR 1253, iBraiN, Université de Tours, INSERM, Tours, France
| | - Coraline Hingray
- CHRU de Nancy, Département de Neurologie, Nancy, France; Pôle Hospitalo-Universitaire de Psychiatrie D'Adultes Du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.
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2
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Scotti-Degnan C, Riisen A, Flynn T. The role of psychology and neuropsychology in pediatric epilepsy surgery evaluation. Curr Probl Pediatr Adolesc Health Care 2024; 54:101592. [PMID: 38555234 DOI: 10.1016/j.cppeds.2024.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Epilepsy is one of the most common neurological problems affecting 470,000 children in the United States. While most youth will achieve seizure freedom using medication, up to a third will continue to have seizures and are therefore considered to have drug-resistant epilepsy (DRE). Children and adolescents with epilepsy are at higher risk of behavioral, cognitive, and emotional disorders. Youth with DRE are at even greater risk of behavioral and emotional problems impacting quality of life and may need to pursue surgical interventions, including resective surgery or device implantation. Due to advances in the evaluation of candidates and surgical options, epilepsy surgery is more effective and has become second-line treatment for youth with DRE. This paper highlights the importance of exploring, assessing, and treating psychological and neuropsychological factors throughout the three phases of the epilepsy surgery process and ways pediatricians can support youth and families.
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Affiliation(s)
- Carinna Scotti-Degnan
- The Children's Hospital of Philadelphia, Assistant Professor, Department of Psychiatry, Associated Faculty of the Perelman School of Medicine at the University of Pennsylvania, United States.
| | - Amanda Riisen
- The Children's Hospital of Philadelphia, Assistant Professor, Department of Psychiatry, Associated Faculty of the Perelman School of Medicine at the University of Pennsylvania, United States.
| | - Thomas Flynn
- The Children's Hospital of Philadelphia, Section Chief, Neuropsychology & Assessment, United States.
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Li HT, Viskaitis P, Bracey E, Peleg-Raibstein D, Burdakov D. Transient targeting of hypothalamic orexin neurons alleviates seizures in a mouse model of epilepsy. Nat Commun 2024; 15:1249. [PMID: 38341419 PMCID: PMC10858876 DOI: 10.1038/s41467-024-45515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Lateral hypothalamic (LH) hypocretin/orexin neurons (HONs) control brain-wide electrical excitation. Abnormally high excitation produces epileptic seizures, which affect millions of people and need better treatments. HON population activity spikes from minute to minute, but the role of this in seizures is unknown. Here, we describe correlative and causal links between HON activity spikes and seizures. Applying temporally-targeted HON recordings and optogenetic silencing to a male mouse model of acute epilepsy, we found that pre-seizure HON activity predicts and controls the electrophysiology and behavioral pathology of subsequent seizures. No such links were detected for HON activity during seizures. Having thus defined the time window where HONs influence seizures, we targeted it with LH deep brain stimulation (DBS), which inhibited HON population activity, and produced seizure protection. Collectively, these results uncover a feature of brain activity linked to seizures, and demonstrate a proof-of-concept treatment that controls this feature and alleviates epilepsy.
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Affiliation(s)
- Han-Tao Li
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 333, Taoyuan, Taiwan
| | - Paulius Viskaitis
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland
| | - Eva Bracey
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland
| | - Daria Peleg-Raibstein
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland
| | - Denis Burdakov
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland.
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Peek SI, Meller S, Twele F, Packer RMA, Volk HA. Epilepsy is more than a simple seizure disorder: Parallels between human and canine cognitive and behavioural comorbidities. Vet J 2024; 303:106060. [PMID: 38123061 DOI: 10.1016/j.tvjl.2023.106060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
Psychiatric and cognitive comorbidities have been known to play a major role in human epilepsy for a long time. People with epilepsy (PWE) frequently express signs of varying psychiatric and cognitive disorders affecting their quality and quantity of life (QoL/QaoL). Over the last few years, research on behavioural comorbidities and their effect on the underlying disease have been performed in canine epilepsy. The following article reviews manifestations of comorbidities in canine epilepsy with an emphasis on patterns of clinical signs and their effects on QoL and QaoL. Cognitive and behavioural alterations in epileptic dogs are mainly represented by fear-/anxiety related behaviour and cognitive impairment (CI). Reduced trainability and altered reactions to daily situations are common results of comorbid changes posing obstacles in everyday life of owners and their dog. In addition, clinical signs similar to attention deficit hyperactivity disorder (ADHD) in humans have been reported. Canine attention-deficit-hyperactivity-disorder-like (c-ADHD-like) behaviour should, however, be evaluated critically, as there are no official criteria for diagnosis of ADHD or ADHD-like behaviour in dogs, and some of the reported signs of c-ADHD-like behaviour could be confused with anxiety-associated behaviour. Many intrinsic and extrinsic factors could potentially influence the development of behavioural and cognitive comorbidities in canine epilepsy. In particular, seizure frequency/severity, signalment and factors concerning disease management, such as pharmacotherapy and nutrition, are closely linked with the presence of the aforementioned comorbid disorders. Further studies of behavioural alterations in epileptic dogs are needed to comprehend the complexity of clinical signs and their multifactorial origin.
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Affiliation(s)
- Saskia I Peek
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Friederike Twele
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | | | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany.
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Jacq G, Fontaine C, Legriel S. Patient-reported outcomes in adults after status epilepticus: A systematic review. Epilepsy Behav 2024; 151:109610. [PMID: 38183929 DOI: 10.1016/j.yebeh.2023.109610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
Impairments after status epilepticus have generally been assessed by physicians, using generic scales. Patient-reported outcomes (PROs) directly reflect each patient's experience and are therefore recommended to improve patient-centered care. The objective of this systematic review was to compile the available information on patient-reported outcomes of adults after status epilepticus. We used Medical Subject Headings terms to search PubMed, Embase, and the Cochrane Library from database inception to February 2023. We excluded reviews, case reports, abstract-only reports, editorials, and publications in languages other than English or French. Studies reporting PROs in adults after SE were eligible. Bias in included studies was assessed using the Newcastle-Ottawa Scale (NOS). Given the heterogeneity in assessment tools and outcomes, most of the results are presented separately for each included study. Only three studies met our criteria. All used an observational cohort design. Two were retrospective and one prospective. Of the 141 patients (76 males and 65 females, mean age 43-63 years), 105 (74.4 %) had a history of epilepsy before status epilepticus. The studies used four epilepsy-specific and five generic tools to assess five patient-reported outcomes: quality of life (n = 141), mental health (depression, n = 81, or anxiety, n = 49), physical health including fatigue (n = 130), return to work (n = 49), and side effects of antiepileptic drugs (n = 81). A single study (n = 81) was of good methodological quality. Health-related quality of life (HRQOL) and mental health were the most extensively studied outcomes, and both were impaired. HRQOL scores ranged from 41.7 ± 11.5 to 48.3 ± 24.5. The prevalence of depression and anxiety varied from 30 % to 36 %, and from 22 % to 62 %, respectively. However, data were not collected before the status epilepticus episode, and the possible impact of this last on the outcomes cannot therefore be assessed. Information on PROs of adults after status epilepticus is extremely scant. Patient-reported outcomes should be collected more widely in adults after status epilepticus.
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Affiliation(s)
- Gwenaëlle Jacq
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles 78150, Le Chesnay cedex, France; IctalGroup, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France.
| | - Candice Fontaine
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles 78150, Le Chesnay cedex, France; IctalGroup, Le Chesnay, France
| | - Stephane Legriel
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles 78150, Le Chesnay cedex, France; IctalGroup, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France
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Tokatly Latzer I, Roullet JB, Gibson KM, Pearl PL. Establishment and validation of a clinical severity scoring system for succinic semialdehyde dehydrogenase deficiency. J Inherit Metab Dis 2023; 46:992-1003. [PMID: 37219411 DOI: 10.1002/jimd.12635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023]
Abstract
Succinic semialdehyde dehydrogenase deficiency (SSADHD) is an inherited metabolic disorder with a variable phenotype and rate of progression. We aimed to develop and validate a clinical severity scoring (CSS) system applicable to the clinical setting and composed of five domains reflecting the principal manifestations of this disorder: cognitive, communication, motor, epilepsy, and psychiatry. A prospectively characterized cohort of 27 SSADHD subjects (55% females, median [IQR] age 9.2 [4.6-16.2] years) who enrolled in the SSADHD Natural History Study were included. The CSS was validated by comparison to an objective severity scoring (OSS) system based on comprehensive neuropsychologic and neurophysiologic assessments, which mirror and complement the domains of the CSS. The total CSS was sex and age-independent, and 80% of its domains lacked interdependence. With increasing age, there was a significant improvement in communication abilities (p = 0.05) and a worsening of epilepsy and psychiatric manifestations (p = 0.004 and p = 0.02, respectively). There was a significant correlation between all the CSS and OSS domain scores, as well as between the total CSS and OSS (R = 0.855, p < 0.001). Additionally, there were no significant demographic or clinical differences in the ratio of individuals in the upper quartile to the lower three quartiles of the CSS and OSS. The SSADHD CSS is validated using objective measures and offers a reliable condition-specific instrument universally applicable in clinical settings. This severity score may be utilized for family and patient counseling, genotype-phenotype correlations, biomarker development, clinical trials, and objective descriptions of the natural history of SSADHD.
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Affiliation(s)
- Itay Tokatly Latzer
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jean-Baptiste Roullet
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - K Michael Gibson
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Karakis I, Boualam N, Moura LM, Howard DH. Quality of life and functional limitations in persons with epilepsy. Epilepsy Res 2023; 190:107084. [PMID: 36657252 DOI: 10.1016/j.eplepsyres.2023.107084] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Epilepsy can reduce quality of life (QOL), functionality, and social participation, but these effects have not been adequately quantified in large, population-based, controlled studies. We sought to evaluate the impact of epilepsy on patients' QOL and employment outcomes. METHODS In this cross-sectional study we used nationally representative, pooled data from the Medical Expenditure Panel Survey (MEPS) household component files for 2010-2018. MEPS is a population-based survey of U.S. community-dwelling persons. We included respondents with condition file records for epilepsy. We also analyzed respondents with records for seizure. The primary outcomes were short form-12 physical and mental health scores. Secondary outcomes included self-rated health status, employment status, educational attainment, school/household/work limitations, and missed workdays. We compared these outcomes between persons with epilepsy (PWE) and age- and gender-matched controls. RESULTS We identified 1078 people with epilepsy, 2344 seizure cases, and 3422 cases of either condition (persons with epilepsy and/or seizures). Epilepsy was associated with a decrease of - 4.0 (95% CI: -5.1 to -2.8) points in SF-12 physical health scores and - 3.1 (95% CI: -4.2 to -1.9) in SF-12 mental health scores. Epilepsy was also associated with decreases in the likelihood of reporting good/very good/excellent health status (-13.3 [95% CI: -16.1 to -10.4] percentage points). Epilepsy was also associated with adverse employment-related outcomes. Specifically, PWE were 17.9 (95% CI: 14.3-21.4) percentage points more likely to report that they had work or household limitations. The associations between outcomes and epilepsy were, in most cases, larger than those between outcomes and other common, chronic conditions. SIGNIFICANCE Epilepsy is associated with worse quality of life and employment-related outcomes. Interventions should aim to improve functioning and patients' ability to maintain employment.
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Affiliation(s)
- Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
| | - Nada Boualam
- Department of Health Policy, Emory University School of Medicine, Atlanta, Georgia
| | - Lidia Mvr Moura
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts. Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - David H Howard
- Department of Health Policy, Emory University School of Medicine, Atlanta, Georgia
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Charfi N, Abid S, Farhat N, Elleuch O, Daoud S, Dammak M, Omri S, Thabet JB, Bouali MM, Mhiri C, Maâlej M. Psychiatric comorbidities in epilepsy patients: results of a Tunisian study. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2023. [DOI: 10.1002/pnp.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Nada Charfi
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Salma Abid
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Nouha Farhat
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Oumayma Elleuch
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Saoussen Daoud
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Mariem Dammak
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Sana Omri
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Jihène Ben Thabet
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Manel Maâlej Bouali
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Chokri Mhiri
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Mohamed Maâlej
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
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Ruggiero RN, Peixoto-Santos JE, Bueno-Junior LS, Valente KD, Leite JP. Editorial: Psychiatric Comorbidities in the Epilepsies: Extensive Mechanisms and Broad Questions. Front Integr Neurosci 2022; 16:951170. [PMID: 35784497 PMCID: PMC9249385 DOI: 10.3389/fnint.2022.951170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rafael Naime Ruggiero
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
- *Correspondence: Rafael Naime Ruggiero
| | - Jose Eduardo Peixoto-Santos
- Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Kette D. Valente
- Institute and Department of Psychiatry, Faculty of Medicine of the University of São Paulo (HCFMUSP), São Paulo, Brazil
| | - Joao Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
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Christensen J, Dreier JW, Sun Y, Linehan C, Tomson T, Marson A, Forsgren L, Granbichler CA, Trinka E, Illiescu C, Malmgren K, Kjellberg J, Ibsen R, Jennum PJ. Estimates of epilepsy prevalence, psychiatric co-morbidity and cost. Seizure 2022; 107:162-171. [PMID: 35811222 DOI: 10.1016/j.seizure.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study estimated epilepsy prevalence, psychiatric co-morbidity and annual costs associated with epilepsy. METHODS We used Danish national health registers to identify persons diagnosed with epilepsy and psychiatric disorders, and persons using antiseizure medication and persons using drugs for psychiatric disorders. We calculated the prevalence of epilepsy and co-morbid psychiatric disorders in Denmark on December 31, 2016, using information on epilepsy and psychiatric disorders based on combinations of hospital contacts and use of antiseizure and psychoactive medication. Further, direct and indirect annual costs associated with epilepsy were calculated using individual-level data from a range of socioeconomic registers. RESULTS There were 5,044,367 persons alive and living in Denmark on December 31, 2016, including 33,628 persons with at least one hospital contact with epilepsy in the previous five years (epilepsy prevalence 0.67% (0.69% males; 0.65% females)). Among these persons with epilepsy, we identified 12,562 (37.4%) persons with a psychiatric disorder or use of drugs used for psychiatric disorders as compared with 801,052 (15.9%) persons in the general population. The estimated total annual individual net costs associated with epilepsy was €30,683. Compared with prevalence estimates on December 31, 2006, the prevalence of epilepsy on December 31, 2016, was slightly higher in the older population and slightly lower in children CONCLUSIONS: Population estimates from national registers provide epilepsy prevalence estimates of approximately 0.6-0.7% - similar to previous reviews of epilepsy prevalence. In addition, the national sample allowed idenitfication of high prevalence of psychiatric disorders and high societal costs associated with epielspy.
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Wang L, Chen J, Hu Y, Liao A, Zheng W, Wang X, Lan J, Shen J, Wang S, Yang F, Wang Y, Li Y, Chen D. Progranulin improves neural development via the PI3K/Akt/GSK-3β pathway in the cerebellum of a VPA-induced rat model of ASD. Transl Psychiatry 2022; 12:114. [PMID: 35318322 PMCID: PMC8941112 DOI: 10.1038/s41398-022-01875-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disease featuring social interaction deficits and repetitive/stereotyped behaviours; the prevalence of this disorder has continuously increased. Progranulin (PGRN) is a neurotrophic factor that promotes neuronal survival and differentiation. However, there have not been sufficient studies investigating its effect in animal models of autism. This study investigated the effects of PGRN on autistic phenotypes in rats treated with valproic acid (VPA) and assessed the underlying molecular mechanisms. PGRN was significantly downregulated in the cerebellum at postnatal day 14 (PND14) and PND35 in VPA-exposed rats, which simultaneously showed defective social preference, increased repetitive behaviours, and uncoordinated movements. When human recombinant PGRN (r-PGRN) was injected into the cerebellum of newborn ASD model rats (PND10 and PND17), some of the behavioural defects were alleviated. r-PGRN supplementation also reduced cerebellar neuronal apoptosis and rescued synapse formation in ASD rats. Mechanistically, we confirmed that PGRN protects neurodevelopment via the PI3K/Akt/GSK-3β pathway in the cerebellum of a rat ASD model. Moreover, we found that prosaposin (PSAP) promoted the internalisation and neurotrophic activity of PGRN. These results experimentally demonstrate the therapeutic effects of PGRN on a rat model of ASD for the first time and provide a novel therapeutic strategy for autism.
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Affiliation(s)
- Lili Wang
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Jianhui Chen
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Yuling Hu
- Qujiang No. 2 Middle School, Xi'an, 710000, China
| | - Ailing Liao
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Wenxia Zheng
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Xiaoqing Wang
- Department of Nuclear Medicine, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, 637000, China
| | - Junying Lan
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100070, China
| | - Jingjing Shen
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Shali Wang
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Feng Yang
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yan Wang
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Yingbo Li
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Di Chen
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China.
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12
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João RB, Nogueira MH, Morita-Sherman ME, Alvim MKM, Johnny S, Pereira H, Pinheiro HP, Cendes F, Yasuda CL. The Relationship Between Depression and Anxiety Symptoms of Adult PWE and Caregivers in a Tertiary Center. Front Neurol 2022; 13:766009. [PMID: 35356450 PMCID: PMC8959587 DOI: 10.3389/fneur.2022.766009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Although several studies have emphasized the association between epilepsy and psychiatric disorders, fewer have investigated the impact of epilepsy on caregivers' emotional status, mainly in adult people with epilepsy (PWE). Here we investigated depressive symptoms, suicidal ideation, and anxiety symptoms in a large group of adult PWE and their caregivers. Methods We analyzed symptoms of depression [with the Beck Depression Inventory-II (BDI-II)], suicidal ideation (with BDI-II item 9), and anxiety symptoms (with the Beck Anxiety Inventory) in a large group of adult PWE [N = 548 (60% women; median age 41)] and caregivers [N = 191 (72% women; median age 47)] from a Brazilian tertiary center, considering sociodemographic and clinical aspects. We also applied the Liverpool Adverse Events Profile to assess anti-seizure drugs adverse events. Results While the presence (p = 0.026) (and intensity, p = 0.007) of depressive symptoms and suicidal ideation (p = 0.02) were higher in PWE compared to caregivers, the proportion of clinical anxiety symptoms (p = 0.32) (and the intensity, p = 0.13) was similar in both groups. Although the rates of suicidal ideation were higher in focal epilepsy (20%), both generalized genetic epilepsy and caregivers also presented elevated frequencies (11%) of suicidal ideation. The analyses of 120 patient-caregiver dyads revealed that the intensity of depressive symptoms in PWE (but not anxiety) correlated with the intensity of depressive (r = 0.35; p < 0.001) and anxiety (r = 0.25; p = 0.01) symptoms in their caregivers. In the multivariate analyses of PWE, focal epilepsy (compared to GGE) was associated with clinical depressive symptoms (odds ratio, OR 2.1) and suicidal ideation (OR 3.2), while recurrent seizures (compared to the seizure-free group) were associated with suicidal ideation (OR 2.6) and anxiety symptoms (OR 2.1). Also, caregivers with anxiety symptoms were 8 times more likely to exhibit depressive symptoms, and those with depressive symptoms were 8 times more likely to present anxiety symptoms. Conclusion Our study suggests that specific attention for the caregivers' mental health is as essential as PWE. There is an urgent need for more studies involving caregivers to identify their emotional distress and provide adequate treatment.
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Affiliation(s)
- Rafael Batista João
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Mateus Henrique Nogueira
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Márcia Elisabete Morita-Sherman
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Marina Koutsodontis Machado Alvim
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Steven Johnny
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Haryton Pereira
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Hildete Prisco Pinheiro
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas, Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Clarissa Lin Yasuda
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
- *Correspondence: Clarissa Lin Yasuda
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13
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Tsamakis K, Teagarden DL, Villarreal HK, Morton ML, Janocko NJ, Groover O, Loring DW, Drane DL, Karakis I. Depression and Anxiety in Adult Persons With Epilepsy and Their Caregivers: A Survey-Based Study at a Tertiary Care Center. J Nerv Ment Dis 2022; 210:212-218. [PMID: 34719659 DOI: 10.1097/nmd.0000000000001436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study evaluated the rates of depression and anxiety and their determinants in adult persons with epilepsy and their caregivers. Both completed surveys about demographic, disease-related, and psychosocial characteristics. One hundred patients and caregivers participated. A mood disorder was present in 89% of patients and 56% of caregivers. In the univariate analysis, the presence of mood disorder in the patient was associated with being unmarried, unemployed, frequent hospitalizations, side effects from polypharmacy, patient stigma, patient quality of life, caregiver anxiety, and caregiver burden. In the multivariate analysis, medication side effects sustained as an important determinant. In the univariate analysis, the presence of mood disorder in the caregiver was associated with seizure frequency, patient anxiety, patient quality of life, caregiver stigma, and caregiver burden. In the multivariate analysis, patient anxiety level and caregiver burden sustained as important determinants. Adult persons with epilepsy and their caregivers experience high rates of mood disorders, explained by certain clinical factors.
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14
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Kedare JS, Baliga SP. Management of Psychiatric Disorders in Patients of Epilepsy. Indian J Psychiatry 2022; 64:S319-S329. [PMID: 35602355 PMCID: PMC9122168 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_17_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 11/05/2022] Open
Abstract
Psychiatric disorders co-occur very frequently with epilepsy. This guideline covers the etiopathogenesis, presentation, evaluation and management of various psychiatric disorders in epilepsy such as mood, anxiety, psychotic and substance use disorders. It also provides an approach to important special issues in this population.
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Affiliation(s)
- Jahnavi S Kedare
- Department of Psychiatry, T. N. Medical College, Mumbai, Maharashtra, India
| | - Sachin P Baliga
- Department of Psychiatry, T. N. Medical College, Mumbai, Maharashtra, India
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15
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Godoy LD, Prizon T, Rossignoli MT, Leite JP, Liberato JL. Parvalbumin Role in Epilepsy and Psychiatric Comorbidities: From Mechanism to Intervention. Front Integr Neurosci 2022; 16:765324. [PMID: 35250498 PMCID: PMC8891758 DOI: 10.3389/fnint.2022.765324] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/24/2022] [Indexed: 12/22/2022] Open
Abstract
Parvalbumin is a calcium-binding protein present in inhibitory interneurons that play an essential role in regulating many physiological processes, such as intracellular signaling and synaptic transmission. Changes in parvalbumin expression are deeply related to epilepsy, which is considered one of the most disabling neuropathologies. Epilepsy is a complex multi-factor group of disorders characterized by periods of hypersynchronous activity and hyperexcitability within brain networks. In this scenario, inhibitory neurotransmission dysfunction in modulating excitatory transmission related to the loss of subsets of parvalbumin-expressing inhibitory interneuron may have a prominent role in disrupted excitability. Some studies also reported that parvalbumin-positive interneurons altered function might contribute to psychiatric comorbidities associated with epilepsy, such as depression, anxiety, and psychosis. Understanding the epileptogenic process and comorbidities associated with epilepsy have significantly advanced through preclinical and clinical investigation. In this review, evidence from parvalbumin altered function in epilepsy and associated psychiatric comorbidities were explored with a translational perspective. Some advances in potential therapeutic interventions are highlighted, from current antiepileptic and neuroprotective drugs to cutting edge modulation of parvalbumin subpopulations using optogenetics, designer receptors exclusively activated by designer drugs (DREADD) techniques, transcranial magnetic stimulation, genome engineering, and cell grafting. Creating new perspectives on mechanisms and therapeutic strategies is valuable for understanding the pathophysiology of epilepsy and its psychiatric comorbidities and improving efficiency in clinical intervention.
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Affiliation(s)
- Lívea Dornela Godoy
- Department of Psychology, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Tamiris Prizon
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Matheus Teixeira Rossignoli
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Pereira Leite
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- João Pereira Leite,
| | - José Luiz Liberato
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- *Correspondence: José Luiz Liberato,
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16
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Operto FF, Pastorino GMG, Pippa F, Padovano C, Vivenzio V, Scuoppo C, Pistola I, Coppola G. Psychiatric Symptoms and Parental Stress in Children and Adolescents With Epilepsy. Front Neurol 2021; 12:778410. [PMID: 34956058 PMCID: PMC8694379 DOI: 10.3389/fneur.2021.778410] [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] [Received: 09/16/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: The aim of this study was to identify the presence of emotional and behavioral symptoms in children and adolescents with epilepsy, to measure the stress levels in their parents, and to determine if and how parental stress was linked to emotional and behavioral symptoms of their children. Methods: We conducted a cross-sectional observational study including 103 children and adolescents with different form of epilepsy and 93 sex-/age-matched controls. Parental stress and emotional and behavioral symptoms were assessed through two standardized questionnaires: the Parenting Stress Index (PSI) and the Child Behavior Checklist (CBCL), respectively. We also considered the following variables: age, sex, maternal education level, family history of psychiatric disorders, duration of epilepsy, seizure frequency, seizure type, and number of antiseizure medications. Results: The statistical comparison showed that the epilepsy group obtained significantly higher scores than controls in almost all the CBCL and the PSI scales (p < 0.05). The correlation analysis revealed a significant relationship between the PSI Total Stress scale and the following CBCL scales: total problems, internalizing problems, and externalizing problems (p < 0.05). An earlier age of seizure onset was related to a greater presence of externalizing problems, total problems, and total stress (p < 0.05). Conclusion: In the epilepsy group, we found higher levels of parental stress and higher presence of emotional and behavioral symptoms compared to controls, mainly represented by internalizing problems (anxiety and depression symptoms). Therefore, it is important to precociously detect these symptoms and monitor them over time, in order to prevent psychiatric problems. In addition, parents of children with epilepsy should be offered psychological support to cope with parental stress and to improve the relationship with their children.
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Affiliation(s)
- Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Federica Pippa
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Chiara Padovano
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Valentina Vivenzio
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Chiara Scuoppo
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Ilaria Pistola
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giangennaro Coppola
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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17
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Tao G, Auvrez C, Nightscales R, Barnard S, McCartney L, Malpas CB, Perucca P, Chen Z, Adams S, McIntosh A, Ignatiadis S, O'Brien P, Cook MJ, Kwan P, Berkovic SF, D'Souza W, Velakoulis D, O'Brien TJ. Association Between Psychiatric Comorbidities and Mortality in Epilepsy. Neurol Clin Pract 2021; 11:429-437. [PMID: 34824893 PMCID: PMC8610550 DOI: 10.1212/cpj.0000000000001114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/07/2021] [Indexed: 01/26/2023]
Abstract
Objective To explore the impact of psychiatric comorbidities on all-cause mortality in adults with epilepsy from a cohort of patients admitted for video-EEG monitoring (VEM) over 2 decades. Methods A retrospective medical record audit was conducted on 2,709 adults admitted for VEM and diagnosed with epilepsy at 3 Victorian comprehensive epilepsy programs from 1995 to 2015. A total of 1,805 patients were identified in whom the record of a clinical evaluation by a neuropsychiatrist was available, excluding 27 patients who died of a malignant brain tumor known at the time of VEM admission. Epilepsy and lifetime psychiatric diagnoses were determined from consensus opinion of epileptologists and neuropsychiatrists involved in the care of each patient. Mortality and cause of death were determined by linkage to the Australian National Death Index and National Coronial Information System. Results Compared with the general population, mortality was higher in people with epilepsy (PWE) with a psychiatric illness (standardized mortality ratio [SMR] 3.6) and without a psychiatric illness (SMR 2.5). PWE with a psychiatric illness had greater mortality compared with PWE without (hazard ratio 1.41, 95% confidence interval 1.02-1.97) after adjusting for age and sex. No single psychiatric disorder by itself conferred increased mortality in PWE. The distribution of causes of death remained similar between PWE with psychiatric comorbidities and those without. Conclusion The presence of comorbid psychiatric disorders in adults with epilepsy is associated with increased mortality, highlighting the importance of identifying and treating psychiatric comorbidities in these patients.
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Affiliation(s)
- Gerard Tao
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Clarissa Auvrez
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Russell Nightscales
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sarah Barnard
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Lara McCartney
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Charles B Malpas
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Piero Perucca
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Zhibin Chen
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sophia Adams
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Anne McIntosh
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sophia Ignatiadis
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Patrick O'Brien
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Mark J Cook
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Patrick Kwan
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Samuel F Berkovic
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Wendyl D'Souza
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Dennis Velakoulis
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Terence J O'Brien
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
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18
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Repeated hippocampal seizures lead to brain-wide reorganization of circuits and seizure propagation pathways. Neuron 2021; 110:221-236.e4. [PMID: 34706219 PMCID: PMC10402913 DOI: 10.1016/j.neuron.2021.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/18/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
Repeated seizure activity can lead to long-term changes in seizure dynamics and behavior. However, resulting changes in brain-wide dynamics remain poorly understood. This is due partly to technical challenges in precise seizure control and in vivo whole-brain mapping of circuit dynamics. Here, we developed an optogenetic kindling model through repeated stimulation of ventral hippocampal CaMKII neurons in adult rats. We then combined fMRI with electrophysiology to track brain-wide circuit dynamics resulting from non-afterdischarge (AD)-generating stimulations and individual convulsive seizures. Kindling induced widespread increases in non-AD-generating stimulation response and ipsilateral functional connectivity and elevated anxiety. Individual seizures in kindled animals showed more significant increases in brain-wide activity and bilateral functional connectivity. Onset time quantification provided evidence for kindled seizure propagation from the ipsilateral to the contralateral hemisphere. Furthermore, a core of slow-migrating hippocampal activity was identified in both non-kindled and kindled seizures, revealing a novel mechanism of seizure sustainment and propagation.
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19
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Balzekas I, Sladky V, Nejedly P, Brinkmann BH, Crepeau D, Mivalt F, Gregg NM, Pal Attia T, Marks VS, Wheeler L, Riccelli TE, Staab JP, Lundstrom BN, Miller KJ, Van Gompel J, Kremen V, Croarkin PE, Worrell GA. Invasive Electrophysiology for Circuit Discovery and Study of Comorbid Psychiatric Disorders in Patients With Epilepsy: Challenges, Opportunities, and Novel Technologies. Front Hum Neurosci 2021; 15:702605. [PMID: 34381344 PMCID: PMC8349989 DOI: 10.3389/fnhum.2021.702605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/29/2021] [Indexed: 01/10/2023] Open
Abstract
Intracranial electroencephalographic (iEEG) recordings from patients with epilepsy provide distinct opportunities and novel data for the study of co-occurring psychiatric disorders. Comorbid psychiatric disorders are very common in drug-resistant epilepsy and their added complexity warrants careful consideration. In this review, we first discuss psychiatric comorbidities and symptoms in patients with epilepsy. We describe how epilepsy can potentially impact patient presentation and how these factors can be addressed in the experimental designs of studies focused on the electrophysiologic correlates of mood. Second, we review emerging technologies to integrate long-term iEEG recording with dense behavioral tracking in naturalistic environments. Third, we explore questions on how best to address the intersection between epilepsy and psychiatric comorbidities. Advances in ambulatory iEEG and long-term behavioral monitoring technologies will be instrumental in studying the intersection of seizures, epilepsy, psychiatric comorbidities, and their underlying circuitry.
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Affiliation(s)
- Irena Balzekas
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
- Mayo Clinic Medical Scientist Training Program, Rochester, MN, United States
| | - Vladimir Sladky
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czechia
| | - Petr Nejedly
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Benjamin H. Brinkmann
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Daniel Crepeau
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Filip Mivalt
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Czechia
| | - Nicholas M. Gregg
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Tal Pal Attia
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Victoria S. Marks
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
| | - Lydia Wheeler
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Tori E. Riccelli
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Jeffrey P. Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Brian Nils Lundstrom
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Kai J. Miller
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Jamie Van Gompel
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Vaclav Kremen
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czechia
| | - Paul E. Croarkin
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Gregory A. Worrell
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
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20
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Gao Y, Zheng J, Jiang T, Pi G, Sun F, Xiong R, Wang W, Wu D, Li S, Lei H, Yu H, Zhou Q, Yang Y, Zhang H, Wang JZ. Targeted Reducing of Tauopathy Alleviates Epileptic Seizures and Spatial Memory Impairment in an Optogenetically Inducible Mouse Model of Epilepsy. Front Cell Dev Biol 2021; 8:633725. [PMID: 33681188 PMCID: PMC7930339 DOI: 10.3389/fcell.2020.633725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Intracellular deposition of hyperphosphorylated tau has been reported in the brain of epilepsy patients, but its contribution to epileptic seizures and the association with spatial cognitive functions remain unclear. Here, we found that repeated optogenetic stimulation of the excitatory neurons in ventral hippocampal CA1 subset could induce a controllable epileptic seizure in mice. Simultaneously, the mice showed spatial learning and memory deficits with a prominently elevated total tau and phospho-tau levels in the brain. Importantly, selective facilitating tau degradation by using a novel designed proteolysis-targeting chimera named C4 could effectively ameliorate the epileptic seizures with remarkable restoration of neuronal firing activities and improvement of spatial learning and memory functions. These results confirm that abnormal tau accumulation plays a pivotal role in the epileptic seizures and the epilepsy-associated spatial memory impairments, which provides new molecular target for the therapeutics.
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Affiliation(s)
- Yang Gao
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Zheng
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Pharmacology, Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Tao Jiang
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guilin Pi
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Sun
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Xiong
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijin Wang
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongqin Wu
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shihong Li
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiyang Lei
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiling Yu
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuzhi Zhou
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Yang
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huaqiu Zhang
- Department of Neurosurgery, Key Laboratory of Ministry of Education for Neurological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian-Zhi Wang
- Department of Pathophysiology, Key Laboratory of Ministry of Education for Neurological Disorders, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
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21
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Sahebi Vaighan N, Delavar Kasmaei H, Hesami O, Azargashb E, Mohtasham Alsharieh A. Evaluation of reliability and validity of the Persian version of the Neurological Disorders Depression Inventory for Epilepsy (P-NDDI-E). Epilepsy Behav 2021; 114:107457. [PMID: 32994073 DOI: 10.1016/j.yebeh.2020.107457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Major depression is common among people with epilepsy (PWE), but it is underdiagnosed. The aim of the present study was to assess the reliability and validity of the Persian version of the Neurological Disorders Depression Inventory for Epilepsy (P-NDDI-E) as a screening tool for major depression in patients with epilepsy. METHOD A total of 210 patients suffering from epilepsy have been assessed using the NDDI-E and the Beck Depression Inventory-II (BDI-II) with no difficulty in understanding or answering the Persian version of the questionnaire. Patients identified as depressed under BDI-II underwent a psychiatric evaluation to confirm depression according to 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) criteria. RESULT According to the BDI-II and the ICD-10 criteria, major depression was diagnosed in 75 patients (32% men, 68% women). Cronbach's α coefficient was 0.826, suggesting a very good internal consistency. The receiver operating characteristic analysis showed an area under the curve of 0.90 (95% confidence interval [CI] = 0.86-0.94, standard error [SE]: 0.02, p < 0.001). A cutoff of ≥14 resulted in an 83% sensitivity, an 80% specificity, a 70.1% positive predictive value, and an 88.6% negative predictive value. A significant and positive correlation between the P-NDDI-E and the BDI-II was shown (Spearman's ρ = 0.604, p < 0.001). DISCUSSION The P-NDDI-E could be used as a reliable and valid instrument in detecting major depression in PWE.
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Affiliation(s)
- Navideh Sahebi Vaighan
- Department of Neurology, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Delavar Kasmaei
- Department of Neurology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Omid Hesami
- Department of Neurology, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Eznollah Azargashb
- Department of Social Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mohtasham Alsharieh
- Department of Psychiatry, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Canzian J, Franscescon F, Müller TE, Stefanello FV, Souza TP, Rosa LV, Rosemberg DB. Stress increases susceptibility to pentylenetetrazole-induced seizures in adult zebrafish. Epilepsy Behav 2021; 114:107557. [PMID: 33243678 DOI: 10.1016/j.yebeh.2020.107557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
Stress is the body's reaction to any change that requires adaptive responses. In various organisms, stress is a seizure-related comorbidity. Despite the exposure to stressors eliciting aversive behaviors in zebrafish, there are no data showing whether stress potentiates epileptic seizures in this species. Here, we investigated whether a previous exposure to an intense acute stressor positively modulates the susceptibility to seizures in pentylenetetrazole (PTZ)-challenged zebrafish. The conspecific alarm substance (CAS) was used to elicit aversive responses (3.5 mL/L for 5 min), observed by increased bottom dwelling and erratic movements. Then, fish were immediately exposed to 7.5 mM PTZ for 10 min to induce seizure-like behaviors. Stress increased the seizure intensity, the number of clonic-like seizure behaviors (score 4), as well as facilitated the occurrence of score 4 episodes by decreasing the latency in which fish reached the score 4. Moreover, fish with heightened anxiety showed increased susceptibility to PTZ, since positive correlations between anxiety- and seizure-like behaviors were found. Overall, since CAS also increased whole-body cortisol levels in zebrafish, our novel findings show a prominent response to PTZ-induced seizures in previously stressed zebrafish. Moreover, we reinforce the growing utility of zebrafish models to assess seizure-related comorbidities aiming to elucidate how stress can affect epileptic seizures in vertebrates.
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Affiliation(s)
- Julia Canzian
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Francini Franscescon
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Talise E Müller
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Flavia V Stefanello
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Thiele P Souza
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Luiz V Rosa
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Denis B Rosemberg
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; The International Zebrafish Neuroscience Research Consortium (ZNRC), 309 Palmer Court, Slidell, LA 70458, USA.
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23
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Campos-Fernández D, Fonseca E, Olivé-Gadea M, Quintana M, Abraira L, Seijo-Raposo I, Santamarina E, Toledo M. The mediating role of epileptic seizures, irritability, and depression on quality of life in people with epilepsy. Epilepsy Behav 2020; 113:107511. [PMID: 33129044 DOI: 10.1016/j.yebeh.2020.107511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Psychiatric comorbidity is common in epilepsy and has a considerable impact on patient quality of life (QoL). This study aimed to analyze the relationship between seizure frequency, irritability, and depression and describe how they mediate each other's effect on QoL in epilepsy. METHODS This is a cross-sectional study of consecutive adults seen at an outpatient epilepsy clinic of a tertiary hospital in Barcelona, Spain. All the patients were evaluated for psychiatric comorbidity and administered the State-Trait Anger Expression Inventory-2 (STAXI-2), the Hospital Anxiety and Depression Scale (HADS), and the Quality Of Life in Epilepsy Inventory-10 (QOLIE-10). Mediation analysis with multiple linear regression followed by the Sobel test was performed. RESULTS We studied 157 patients. Seizure frequency (R = -0.193, P = .053), irritability (R = 0.216, P = .039), and depression (R = -0.598, P < .001) had all a negative effect on QoL. In the adjusted linear regression model, depression was the only independent predictor of impaired QoL (B = -2.453 [95% confidence interval (CI): -3.161, -1.744], P < .001). The Sobel test showed that depression exerted a significant mediating effect on seizure frequency (Z = -1.984; P = .047) and irritability (Z = -3.669; P < .001) in their influence on QoL. CONCLUSION Depression is an independent predictor of worse QoL and significantly mediated the effects of irritability and poor seizure control on QoL impairment in patients with epilepsy.
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Affiliation(s)
- Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Marta Olivé-Gadea
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Iván Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Kirabira J, Lam A, Ssuna B, Rukundo GZ. Psychiatric disorders among children and adolescents with active epilepsy in southwestern Uganda. PAMJ ONE HEALTH 2020; 3:9. [PMID: 34604861 PMCID: PMC8486297 DOI: 10.11604/pamj-oh.2020.3.9.25146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION the study aimed to determine the prevalence of emotional, behavioral, developmental and psychosis related disorders among children and adolescents with active epilepsy aged 5 to 18 years in southwestern Uganda. METHODS we conducted a cross sectional study at one big urban hospital, two rural health centers and one rural special needs school. The disorders were assessed using an adapted parent version of the Child and Adolescent Symptom Inventory-5 (CASI-5). RESULTS one hundred and sixty-one participants were assessed, and 93 (57.8%) had at least one psychiatric disorder. Developmental disorders were the most prevalent at 39.8% (95%CI 32.11 - 47.39), followed by emotional disorders, 30.4% (95%CI 23.25-37.62), behavioral disorders, 7.5% (95%CI 3.35-11.55) and psychosis related disorders, 6.2% (95%CI 2.44 - 9.98). Thirty-nine participants (24.2%) had at least two psychiatric disorders. Developmental disorders were associated with younger age (aOR=0.86, p=0.001) and having epilepsy-related physical injuries and deformities (aOR=2.36, p=0.036). Emotional disorders (aOR=1.13, p=0.007) and psychosis related disorders (aOR=1.44, p=0.007) were associated with increasing age, whereas a family history of epilepsy was protective (aOR=0.22, p=0.042). CONCLUSION psychiatric disorders were highly prevalent among children and adolescents with epilepsy in southwestern Uganda; highlighting the need to integrate screening and management of these disorders into routine epilepsy care.
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Affiliation(s)
- Joseph Kirabira
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
- Department of Mental Health, Gulu University, PO Box 166, Gulu, Uganda
- Department of Mental Health and Psychiatry, Kampala International University, Western Campus, PO Box 71, Bushenyi, Uganda
| | - Alice Lam
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bashir Ssuna
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences (MakCHS), Kampala, Uganda
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25
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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
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26
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McCartney L, Johnstone B, O'Brien T, Kwan P, Kalincik T, Velakoulis D, Malpas C. Psychometric properties of the Hospital Anxiety and Depression Scale in an inpatient video-monitoring epilepsy cohort. Epilepsy Behav 2020; 103:106631. [PMID: 31870806 DOI: 10.1016/j.yebeh.2019.106631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with epilepsy (PWE) have high rates of comorbid anxiety disorders and depressive disorders, from 25% in general population cohorts to rates of 55% in people with treatment resistant epilepsy. High rates are also seen in patients with psychogenic nonepileptic seizures (PNES). Depressive disorders and anxiety disorders in PWE are associated with decreased quality of life measures and are the strongest risk factors for increased suicidality, rates of which are markedly elevated in PWE, at 12%, compared to the general Australian population (1.8%). The Hospital Anxiety and Depression Scale (HADS) is one of the more commonly used screening tools in medical populations. Past studies of the HADS in general outpatient populations with epilepsy have demonstrated promising validity for detecting depression. OBJECTIVES The following were the objectives of the study: 1. To examine the validity of HADS in detecting depressive disorders and anxiety disorders in an inpatient population of patients admitted for video monitoring. 2. To investigate the measurement structure of the HADS across the diagnosis groups of epilepsy subtypes and PNES. METHODS This was a retrospective cohort study of 485 patients admitted to a tertiary epilepsy video electroencephalography (EEG) monitoring unit. All patients received clinical neurological, neuropsychiatric, and neuroimaging assessments to arrive at consensus epilepsy and psychiatric diagnoses. Clinical psychiatric diagnosis of depressive disorders and anxiety disorders, based on the assessment of a neuropsychiatrist, were compared to accepted HADS cutoff scores for these conditions. FINDINGS Of the 485 patients, 229 patients were with epilepsy, 28 had both epilepsy and PNES, and 121 had PNES. In 107 cases, no definite diagnosis could be made. At a cutoff score of 7 HADS was able to significantly classify patients with depression (area under the curve [AUC] = 0.79, 95% confidence interval [CI] = 0.72-0.82) with a sensitivity of 70% and a specificity of 83%. A similar result was observed for anxiety disorders; a cutoff score of 7 (AUC = 0.75, 95% CI = 0.72-0.81) was able to significantly classify anxiety disorders in patients with a sensitivity of 88% and specificity of 54%. CONCLUSIONS This study has found that HADS measures two separate, yet correlated, constructs of anxiety disorders and depressive disorders. Our results indicate that while the HADS is sensitive to distress in this population, relatively low cutoff scores would be required to achieve highly sensitive screening. This sample includes patients with a diagnosis of epilepsy and/or PNES, and thus, the findings have clinical applicability to screening in tertiary epilepsy video-EEG monitoring units where both these conditions frequently co-occur.
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Affiliation(s)
- Lara McCartney
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia.
| | - Benjamin Johnstone
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Terence O'Brien
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia
| | - Patrick Kwan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia
| | - Tomas Kalincik
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; CORe, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Dennis Velakoulis
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Charles Malpas
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia; CORe, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
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Baroli G, Sanchez JR, Agostinelli E, Mariottini P, Cervelli M. Polyamines: The possible missing link between mental disorders and epilepsy (Review). Int J Mol Med 2019; 45:3-9. [PMID: 31746386 DOI: 10.3892/ijmm.2019.4401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/22/2019] [Indexed: 11/05/2022] Open
Abstract
Polyamines are small positively charged alkylamines that are essential in a number of crucial eukaryotic processes, like normal cell growth and development. In normal physiological conditions, intracellular polyamine content is tightly regulated through a fine regulated network of biosynthetic and catabolic enzymes and a transport system. The dysregulation of this network is frequently associated to different tumors, where high levels of polyamines has been detected. Polyamines also modulate ion channels and ionotropic glutamate receptors and altered levels of polyamines have been observed in different brain diseases, including mental disorders and epilepsy. The goal of this article is to review the role of polyamines in mental disorders and epilepsy within a frame of the possible link between these two brain pathologies. The high comorbidity between these two neurological illnesses is strongly suggestive that they share a common background in the central nervous system. This review proposes an additional association between the noradrenalin/serotonin and glutamatergic neuronal circuits with polyamines. Polyamines can be considered supplementary defensive shielding molecules, important to protect the brain from the development of epilepsy and mental illnesses that are caused by different types of neurons. In this contest, the modulation of polyamine metabolism may be a novel important target for the prevention and therapeutic treatment of these diseases that have a high impact on the costs of public health and considerably affect quality of life.
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Affiliation(s)
- Giulia Baroli
- Department of Science, University of Rome 'Roma Tre', I‑00146 Rome, Italy
| | | | - Enzo Agostinelli
- Department of Biochemical Sciences 'Rossi Fanelli', University of Rome 'La Sapienza', I‑00185 Rome, Italy
| | - Paolo Mariottini
- Department of Science, University of Rome 'Roma Tre', I‑00146 Rome, Italy
| | - Manuela Cervelli
- Department of Science, University of Rome 'Roma Tre', I‑00146 Rome, Italy
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Shiota MN, Simpson ML, Kirsch HE, Levenson RW. Emotion recognition in objects in patients with neurological disease. Neuropsychology 2019; 33:1163-1173. [PMID: 31478721 PMCID: PMC6823118 DOI: 10.1037/neu0000587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Considerable research indicates that individuals with dementia have deficits in the ability to recognize emotion in other people. The present study examined ability to detect emotional qualities of objects. METHOD Fifty-two patients with frontotemporal dementia (FTD), 20 patients with Alzheimer's disease (AD), 18 patients awaiting surgery for intractable epilepsy, and 159 healthy controls completed a newly developed test of ability to recognize emotional qualities of art (music and paintings), and pleasantness in simple sensory stimuli (tactile, olfactory, auditory), and to make aesthetic judgments (geometric shapes, room décor). A subset of participants also completed a test of ability to recognize emotions in other people. RESULTS Patients with FTD showed a marked deficit in ability to recognize the emotions conveyed in art, compared with both healthy individuals and patients with AD (relative to controls, deficits in patients with AD only approached significance). This deficit remained robust after controlling for FTD patients' ability to recognize pleasantness in simple sensory stimuli, make aesthetic judgments, identify odors, and identify emotions in other people. Neither FTD nor AD patients showed deficits in recognizing pleasant sensory stimuli or making aesthetic judgments. Exploratory analysis of patients with epilepsy revealed no deficits in any of these domains. CONCLUSION Patients with FTD (but not AD) showed a significant, specific deficit in ability to interpret emotional messages in art, echoing FTD-related deficits in recognizing emotions in other people. This finding adds to our understanding of the impact these diseases have on the lives of patients and their caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Sarrouilhe D, Mesnil M, Dejean C. Targeting Gap Junctions: New Insights into the Treatment of Major Depressive Disorder. Curr Med Chem 2019; 26:3775-3791. [DOI: 10.2174/0929867325666180327103530] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/22/2017] [Accepted: 03/21/2018] [Indexed: 01/05/2023]
Abstract
Background:Major depressive disorder (MDD) is a multifactorial chronic and debilitating mood disease with high lifetime prevalence and associated with excess mortality. Treatments for this disease are not effective in all patients showing the need to find new therapeutic targets.Objective:This review aims to update our knowledge on the involvement of astroglial gap junctions and hemichannels in MDD and to show how they have become potential targets for the treatment of this pathology.Methods:The method applied in this review includes a systematic compilation of the relevant literature.Results and Conclusion:The use of rodent models of depression, gene analysis of hippocampal tissues of MDD patients and post-mortem studies on the brains from MDD patients suggest that astrocytic gap junction dysfunction may be a part of MDD etiologies. Chronic antidepressant treatments of rats, rat cultured cortical astrocytes and human astrocytoma cell lines support the hypothesis that the up-regulation of gap junctional coupling between astrocytes could be an underlying mechanism for the therapeutic effect of antidepressants. However, two recent functional studies suggest that connexin43 hemichannel activity is a part of several antidepressants’ mode of action and that astrocyte gap junctional intercellular communication and hemichannels exert different effects on antidepressant drug response. Even if they emerge as new therapeutic targets for new and more active treatments, further studies are needed to decipher the sophisticated and respective role of astrocytic gap junctions and hemichannels in MDD.
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Affiliation(s)
- Denis Sarrouilhe
- Laboratoire de Physiologie Humaine, Faculte de Medecine et Pharmacie, Universite de Poitiers, 6 rue de la Miletrie, Bat D1, TSA 51115, 86073 Poitiers, Cedex 9, France
| | - Marc Mesnil
- STIM, ERL 7003, CNRS-Universite de Poitiers, Pole Biologie Sante, Bat B36, TSA 51106, 1 rue Georges Bonnet, 86073 Poitiers, Cedex 9, France
| | - Catherine Dejean
- Service Pharmacie, Pavillon Janet, Centre Hospitalier Henri Laborit, 370 avenue Jacques Coeur, 86021 Poitiers Cedex, France
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Christensen J, Pedersen HS, Fenger-Grøn M, Fann JR, Jones NC, Vestergaard M. Selective serotonin reuptake inhibitors and risk of epilepsy after traumatic brain injury - A population based cohort study. PLoS One 2019; 14:e0219137. [PMID: 31323024 PMCID: PMC6641473 DOI: 10.1371/journal.pone.0219137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Traumatic brain injury (TBI) is common and associated with a marked increased risk of developing epilepsy. Animal studies indicate that treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of epilepsy after TBI. The aim of this study was to investigate whether use of SSRIs modifies the risk of epilepsy after TBI. METHODS This was a cohort study of 205,715 persons, who suffered a TBI in Denmark from 1996 to 2013. For each person with TBI, we matched 10 reference persons (N = 2,057,150) who were alive on the day of TBI and who had the same age and gender but had no history of TBI. We used a stratified Cox regression to calculate the relative risk of epilepsy after TBI for persons exposed to TBI, SSRI or both after adjustment for income, civil status, medical and neurological comorbidities, severe mental disease, and substance abuse. RESULTS The risk of epilepsy was 5.61 times higher for persons who used SSRI at time of TBI (adjusted Hazard Ratio (aHR): 5.61 (95% CI: 4.88; 6.45)), 3.23 times higher for persons who had a TBI but did not use SSRI at time of TBI (aHR: 3.23 (95% CI: 3.12;3.35)), and 1.31 times higher for persons who used SSRI but had no TBI (aHR: 1.31 (95% CI: 1.18; 1.45)) compared to persons unexposed to both TBI and SSRI. CONCLUSIONS This large population based cohort study showed that people using SSRI at the time of a TBI had higher risk of developing epilepsy compared to people not using SSRI at the time of TBI. The results are in line with those of animal studies and calls for further studies to evaluate whether the association is due to SSRIs or to the underlying disease (e.g. depression or anxiety).
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Affiliation(s)
- Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Schou Pedersen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Morten Fenger-Grøn
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jesse R. Fann
- Department of Psychiatry, University of Washington, Seattle, Washington, United States of America
| | - Nigel C. Jones
- Department of Medicine (RMH), University of Melbourne, Melbourne Brain Centre, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University and Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mogens Vestergaard
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Zingano BDL, Guarnieri R, Diaz AP, Schwarzbold ML, Wolf P, Lin K, Walz R. Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory (STAI) accuracy for anxiety disorders detection in drug-resistant mesial temporal lobe epilepsy patients. J Affect Disord 2019; 246:452-457. [PMID: 30599368 DOI: 10.1016/j.jad.2018.12.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/18/2018] [Accepted: 12/23/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most prevalent type of surgically remediable epilepsy and highly associated with psychiatric comorbidities. This study aimed to evaluate Hospital anxiety and depression scale-anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory - Trait subscale (STAI-T) accuracy for detection of anxiety disorders in patients with drug-resistant MTLE-HS. METHODS One hundred three consecutive patients with drug-resistant MTLE-HS were enrolled. Diagnosis was based on the anamnesis, neurological examination, video-electroencephalogram (VEEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HADS-A and STAI-T were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. RESULTS The areas under the curve (AUCs) were higher than 0.7 (0.6-0.8) for both scales. The STAI-T cutoff point of ˃53 and the HADS-A cutoff point of ˃7 showed both around of 80% (44.4-97.7) sensitivity and 80% (66.9-86.9) and 60% (46.5-68.6) of specificity, respectively. In this sample the prevalence of anxiety disorders was 11.7% and both scales showed a high negative predictive value such as 96% (87.1-99.0) but low positive predictive value such as 30% (22.1-45.2) and 20% (15.0-27.2) respectively. LIMITATIONS The small number of cases in the diagnostic population; the results are only applied to drug resistant MTLE-HS; the psychiatric diagnosis were not based on a structured psychiatric interview; possible observer bias in 7 illiterate patients; the antidepressant treatment was not controlled. CONCLUSIONS In MTLE-HS, STAI-T and HADS-A had a similar and low positive predictive value and high negative predictive value. The implications for the HADS-A and STAI-T usefulness for anxiety disorders screening in patients with other epilepsies types deserve further investigations. If replicated in other populations, these findings may have important relevance for the presurgical screening of anxiety disorders in MTLE-HS patients who are candidates to epilepsy surgery.
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Affiliation(s)
- Bianca de Lemos Zingano
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil.
| | - Ricardo Guarnieri
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil
| | - Alexandre Paim Diaz
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina (UNISUL), Palhoça, SC, Brazil
| | - Marcelo Libório Schwarzbold
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil
| | - Peter Wolf
- Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Center, Dianalund, Denmark
| | - Katia Lin
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
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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.
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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.
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Garg N, Joshi R, Medhi B. Cracking novel shared targets between epilepsy and Alzheimer's disease: need of the hour. Rev Neurosci 2018; 29:425-442. [PMID: 29329108 DOI: 10.1515/revneuro-2017-0064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/12/2017] [Indexed: 12/14/2022]
Abstract
Epilepsy and Alzheimer's disease (AD) are interconnected. It is well known that seizures are linked with cognitive impairment, and there are various shared etiologies between epilepsy and AD. The connection between hyperexcitability of neurons and cognitive dysfunction in the progression of AD or epileptogenesis plays a vital role for improving selection of treatment for both diseases. Traditionally, seizures occur less frequently and in later stages of age in patients with AD which in turn implies that neurodegeneration causes seizures. The role of seizures in early stages of pathogenesis of AD is still an issue to be resolved. So, it is well timed to analyze the common pathways involved in pathophysiology of AD and epilepsy. The present review focuses on similar potential underlying mechanisms which may be related to the causes of seizures in epilepsy and cognitive impairment in AD. The proposed review will focus on many possible newer targets like abnormal expression of various enzymes like GSK-3β, PP2A, PKC, tau hyperphosphorylation, MMPs, caspases, neuroinflammation and oxidative stress associated with number of neurodegenerative diseases linked with epilepsy. The brief about the prospective line of treatment of both diseases will also be discussed in the present review.
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Affiliation(s)
- Nitika Garg
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 1600142, Punjab, India
| | - Rupa Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 1600142, Punjab, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 1600142, Punjab, India, e-mail:
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Ramos-Perdigués S, Baillés E, Mané A, Carreño M, Donaire A, Rumià J, Bargalló N, Boget T, Setoain X, Valdés M, Pintor L. Psychiatric Symptoms in Refractory Epilepsy During the First Year After Surgery. Neurotherapeutics 2018; 15:1082-1092. [PMID: 30066084 PMCID: PMC6277301 DOI: 10.1007/s13311-018-0652-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Psychiatric morbidity in drug-resistant epilepsy is frequent. Surgery is the best therapeutic alternative for treating seizures, but the current evidence concerning the effects of surgery on psychiatric disorders (PDs) is inconclusive. We aim to clarify surgery's role in long-term PDs. Using a prospective controlled study, we analyzed the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not due to not being suitable. Surgical candidates were paired (n = 84) with the immediately following nonsurgical candidates (n = 68). Both groups continued their usual medical treatment. We studied psychiatric changes for each group and analyzed de novo and remission cases. The assessments were made during the presurgical evaluation, and at 6 months (6-M) and 12 months (12-M) after surgery. Finally, we determined associated factors for postsurgical PDs. At 12 months, using the Hospital Anxiety and Depression Scale (HADS), anxiety improved in both groups (p = 0.000), while depression improved only in the surgical group (p = 0.016). Moreover, all symptom dimensions on the Symptom Checklist-90-R (SCL-90), as well as severity, distress, and total symptoms, decreased only in the surgical group. These ameliorations reached not only statistical significance but also clinical significance for depression (HADS) (p = 0.014) and the interictal dysphoric disorder (p = 0.013). The main predictors for PDs after surgery were as follows: the presurgical and 6-month psychiatric symptoms, the absence of surgery, seizure outcomes, and some antiepileptic and psychiatric drugs. This study provides evidence that surgery for epilepsy could have a role in improving some symptoms of psychiatric disorders 12-M after the surgery.
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Affiliation(s)
- Sònia Ramos-Perdigués
- Sant Joan de Déu Terres de Lleida Hospital, Avinguda de la Canadiense, 28, 25001, Lleida, Catalonia, Spain.
- Nostra Senyora de Meritxell Hospital, Escaldes-Engordany, AD700, Andorra.
| | - Eva Baillés
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, 08002, Spain
- Autonomous University of Barcelona, Barcelona, 08193, Spain
| | - Anna Mané
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar and Foundation IMIM, Barcelona, 08003, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, 28029, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Nuria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Manuel Valdés
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
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Tao L, Zhang X, Duan Z, Wang Y, Liu J, Hou H, Fang Q. Sexual dysfunction and associated factors in Chinese Han women with epilepsy. Epilepsy Behav 2018; 85:150-156. [PMID: 29940378 DOI: 10.1016/j.yebeh.2018.06.003] [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: 04/21/2018] [Revised: 05/28/2018] [Accepted: 06/01/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Women with epilepsy (WWE) are believed to be at risk of sexual dysfunction (SD) and face many sexual challenges because of multiple factors. This study aimed to assess the factors associated with SD in Chinese Han WWE. METHODS This cross-sectional study examined 112 married WWE in the Affiliated Hospital of Yangzhou University with focal (FE) or generalized epilepsy (GE) on antiepileptic drugs (AEDs), and 120 healthy controls without epilepsy, all of Chinese Han nationality. Data collection tools included the Chinese version of Female Sexual Function Index (FSFI), the Chinese version of Zung Self-Rating Anxiety Scale (SAS), the Chinese version of the Zung Self-Rating Depression Scale (SDS), the Chinese version of the revised Morisky Medication Adherence Scale (MMAS-8), and the Chinese version of the National Hospital Seizure Severity Scale (NHS3). Chi-square test, t-test, one-way analysis of variance (ANOVA), and binary logistic regression were used for statistical analysis. RESULTS A high rate (70.5%) of SD was detected in WWE, with 24.2% in controls. Sexual dysfunction affected all dimensions: desire (85.7%), arousal (56.3%), lubrication (47.3%), orgasm (66.1%), satisfaction (58.9%), and pain (41.1%). Elevated rates of anxiety (40.2%) and depression (33%) and poor medication adherence (31.3%) were also found in WWE. Binary logistic regression found that poor economic status (odds ratio (OR) = 13.904, 95% confidence interval (CI): 2.025-95.472, P = 0.007 and OR = 6.350, 95% CI: 1.323-30.477, P = 0.021), anxiety (OR = 1.222, 95% CI: 1.055-1.415, P = 0.007), and poor medication adherence (OR = 0.297, 95% CI: 0.124-0.707, P = 0.006) were associated with SD. CONCLUSIONS The associated factors of SD in Chinese Han WWE are multifactorial. The WWE have higher levels of anxiety, poor family economic status, and poor medication adherence. Medical professionals should not only better control seizures but also evaluate and improve patients' sexual function so as to improve the quality of life of WWE.
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Affiliation(s)
- Lihong Tao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China; Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Xinjiang Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Zuowei Duan
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Yingge Wang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Jiangbing Liu
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Hongling Hou
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
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Aguilar BL, Malkova L, N'Gouemo P, Forcelli PA. Genetically Epilepsy-Prone Rats Display Anxiety-Like Behaviors and Neuropsychiatric Comorbidities of Epilepsy. Front Neurol 2018; 9:476. [PMID: 29997563 PMCID: PMC6030811 DOI: 10.3389/fneur.2018.00476] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/01/2018] [Indexed: 01/09/2023] Open
Abstract
Epilepsy is associated with a variety of neuropsychiatric comorbidities, including both anxiety and depression. Despite high occurrences of depression and anxiety seen in human epilepsy populations, little is known about the etiology of these comorbidities. Experimental models of epilepsy provide a platform to disentangle the contribution of acute seizures, genetic predisposition, and underlying circuit pathologies to anxious and depressive phenotypes. Most studies to date have focused on comorbidities in acquired epilepsies; genetic models, however, allow for the assessment of affective phenotypes that occur prior to onset of recurrent seizures. Here, we tested male and female genetically epilepsy-prone rats (GEPR-3s) and Sprague-Dawley controls in a battery of tests sensitive to anxiety-like and depressive-like phenotypes. GEPR-3s showed increased anxiety-like behavior in the open field test, elevated plus maze, light-dark transition test, and looming threat test. Moreover, GEPR-3s showed impaired prepulse inhibition of the acoustic startle reflex, decreased sucrose preference index, and impaired novel object recognition memory. We also characterized defense behaviors in response to stimulation thresholds of deep and intermediate layers of the superior colliculus (DLSC), but found no difference between strains. In sum, GEPR-3s showed inherited anxiety, an effect that did not differ significantly between sexes. The anxiety phenotype in adult GEPR-3s suggests strong genetic influences that may underlie both the seizure disorder and the comorbidities seen in epilepsy.
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Affiliation(s)
- Brittany L Aguilar
- Interdisciplinary Program in Neuroscience, Georgetown University, Washington, DC, United States.,Department of Pharmacology and Physiology, Georgetown University, Washington, DC, United States
| | - Ludise Malkova
- Interdisciplinary Program in Neuroscience, Georgetown University, Washington, DC, United States.,Department of Pharmacology and Physiology, Georgetown University, Washington, DC, United States
| | - Prosper N'Gouemo
- Interdisciplinary Program in Neuroscience, Georgetown University, Washington, DC, United States.,Department of Pediatrics, Georgetown University, Washington, DC, United States
| | - Patrick A Forcelli
- Interdisciplinary Program in Neuroscience, Georgetown University, Washington, DC, United States.,Department of Pharmacology and Physiology, Georgetown University, Washington, DC, United States.,Department of Neuroscience, Georgetown University, Washington, DC, United States
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Abstract
Bipolar I disorder and interictal personality syndrome have many overlapping characteristics that are difficult to distinguish. There is scant literature focused on interictal personality syndrome and no case reports to date detailing patients with comorbid bipolar pathology. We describe an individual with a history of bipolar I disorder who developed right temporal lobe epilepsy after several head injuries. He subsequently exhibited symptoms consistent with interictal personality syndrome that were independent of his bipolar symptomatology. Better understanding of these disorders can lead to improved diagnosis and symptom management. The similarities may also point to a partially shared neuropathology.
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38
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Gonçalves EB, de Oliveira Cardoso TAM, Yasuda CL, Cendes F. Depressive disorders in patients with pharmaco-resistant mesial temporal lobe epilepsy. J Int Med Res 2018; 46:752-760. [PMID: 29239239 PMCID: PMC5971495 DOI: 10.1177/0300060517717825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
Objectives To assess depressive disorders in patients with mesial temporal lobe epilepsy (MTLE) refractory to medical treatment. Methods Adult patients with refractory MTLE completed two questionnaires (Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory (BDI) had a semi-structured psychiatric interview and a high resolution MRI scan. For complete neuropsychiatric diagnosis, as per International Classification of Diseases (ICD-10), the results were combined with clinical history and additional information from the patients' family. Results Of the 40 patients identified for this case series study which took place from 2008-2012, 31 (77.5%) had a depressive disorder: 14 had dysthymia, 11 had recurrent depressive disorder and 6 had bipolar disorder. Of the nine patients without a firm diagnosis of mood disorder, seven had isolated symptoms of depression or anxiety and two presented with mixed depression/anxiety symptoms. Only 8/31 (25.8%) patients were receiving antidepressant treatment. There was no association between BDI scores and seizure frequency. No significant difference was found between patients with and without depression and the presence or laterality of HA. Conclusions Depressive disorders are common, underdiagnosed and undertreated in patients with refractory MTLE.
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Affiliation(s)
| | | | - Clarissa Lin Yasuda
- Department of Neurology, University of Campinas – UNICAMP, Campinas, Sao Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, University of Campinas – UNICAMP, Campinas, Sao Paulo, Brazil
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Cianchetti C, Bianchi E, Guerrini R, Baglietto MG, Briguglio M, Cappelletti S, Casellato S, Crichiutti G, Lualdi R, Margari L, Romeo A, Beghi E. Symptoms of anxiety and depression and family's quality of life in children and adolescents with epilepsy. Epilepsy Behav 2018; 79:146-153. [PMID: 29289902 DOI: 10.1016/j.yebeh.2017.11.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/23/2017] [Accepted: 11/26/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We studied children and adolescents with epilepsy (CAWE) and their families to evaluate symptoms of anxiety and depression, quality of life (QoL), and their correlations with epilepsy characteristics. MATERIAL AND METHODS The study included 326 (52.5% females) 8 to 18years old CAWE. Anxiety and depression were assessed with the "Self-administered psychiatric scales for children and adolescents" (SAFA), and family's QoL with the parents' report "Impact of Epilepsy on QoL" (IEQoL). RESULTS The CAWE exhibiting abnormal (T≥70) scores were 8.0% in the anxiety scale, 9.2% in the depression scale, and 4.6% in both scales. Social anxiety was the predominant anxiety symptom, while irritable mood and desperation were the most frequent symptoms of depression. Depressive symptoms were associated with parents' complaint of higher worries about the child's condition and future and lower well-being of the family. Severity and duration of the epilepsy and polypharmacy were independent from abnormal scores of anxiety and depression, but were associated with parents' worries about the child's condition and family's well-being. CONCLUSIONS Anxiety and depression in CAWE are independent from the characteristics of the disease but are correlated to the lower well-being of the family. A search of these emotional problems is recommended for better care of the patients and their families.
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Affiliation(s)
- Carlo Cianchetti
- Child and Adolescent Neuropsychiatry, University of Cagliari, Italy.
| | - Elisa Bianchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri", IRCCS, Milano, Italy
| | - Renzo Guerrini
- Neuroscience Dept., Children's Hospital A. Meyer, University of Firenze, Italy
| | | | | | - Simona Cappelletti
- Clinical Psychology Unit, Neuroscience Dept., Bambino Gesù Children's Hospital, Roma, Italy
| | - Susanna Casellato
- Epilepsy Unit, Child and Adolescent Neuropsychiatry, University of Sassari, Italy
| | | | - Rosa Lualdi
- Medical Area Dept, University of Udine, Italy
| | - Lucia Margari
- Child and Adolescent Neuropsychiatry, University of Bari, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri", IRCCS, Milano, Italy
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40
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Dehn LB, Pfäfflin M, Brückner S, Lutz MT, Steinhoff BJ, Mayer T, Bien CG, Nussbeck FW, May TW. Relationships of depression and anxiety symptoms with seizure frequency: Results from a multicenter follow-up study. Seizure 2017; 53:103-109. [DOI: 10.1016/j.seizure.2017.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023] Open
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Medel-Matus JS, Shin D, Sankar R, Mazarati A. Kindling epileptogenesis and panic-like behavior: Their bidirectional connection and contribution to epilepsy-associated depression. Epilepsy Behav 2017; 77:33-38. [PMID: 29107199 PMCID: PMC5705456 DOI: 10.1016/j.yebeh.2017.10.001] [Citation(s) in RCA: 19] [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: 08/11/2017] [Revised: 09/28/2017] [Accepted: 10/01/2017] [Indexed: 11/17/2022]
Abstract
Anxiety is one of the most common comorbidities of epilepsy, which has major detrimental effects on the quality of life. Generalized anxiety disorder (GAD) associated with epilepsy has been receiving most attention. However, several other forms of anxiety reportedly present in patients with epilepsy, including panic disorder (PD). In this study, using an animal model of limbic epilepsy, we examined the interplay between epilepsy and panic-like behavior (PLB). Further, considering the high degree of comorbidity between depression on the one hand, and both epilepsy and PD on the other hand, we studied whether and how the presence of PLB in animals with epilepsy would affect their performance in depression-relevant tests. Fifty-day-old male Wistar rats were subjected to repeated alternating electrical stimulations of the basolateral amygdala (BLA) to induce kindling of limbic seizures, and the dorsal periaqueductal gray (DPAG) to induce panic-like episodes. Seizure susceptibility and panic reaction threshold were examined before the first and 24h after the last stimulation. At the end of the stimulations, the rats were examined in depression-relevant tests: saccharin preference test (SPT) for anhedonia and forced swimming test (FST) for despair/hopelessness. With regard to kindling, BLA+DPAG stimulation induced more profound increase of seizure susceptibility than BLA stimulation alone (evident as the reduction of the afterdischarge threshold and the increase of the afterdischarge duration). With regard to PLB, the BLA+DPAG stimulation exacerbated the severity of panic-like episodes, as compared with the DPAG stimulation alone. Basolateral amygdala stimulation alone had no effects on panic-like reactions, and DPAG stimulation alone did not modify kindling epileptogenesis. Combined stimulation of BLA and DPAG induced depressive-like behavioral impairments. This is the first experimental study showing bidirectional, mutually exacerbating effect of epilepsy and PLB, and the precipitation of depressive-like state by the epilepsy-PLB comorbidity.
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Affiliation(s)
| | - Don Shin
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Raman Sankar
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Children's Discovery and Innovation Institute, Los Angeles, CA, USA
| | - Andrey Mazarati
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Children's Discovery and Innovation Institute, Los Angeles, CA, USA
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42
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Shafran R, Bennett SD, McKenzie Smith M. Interventions to Support Integrated Psychological Care and Holistic Health Outcomes in Paediatrics. Healthcare (Basel) 2017; 5:E44. [PMID: 28812985 PMCID: PMC5618172 DOI: 10.3390/healthcare5030044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022] Open
Abstract
There are strong calls from many national and international bodies for there to be a 'holistic' and integrated approach to the understanding and management of psychological and physical health needs. Such holistic approaches are characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease. Holistic approaches can impact on mental and physical health and are cost-effective. Several psychological interventions have demonstrated efficacy in improving holistic health outcomes, for example Cognitive Behaviour Therapy, Behavioural Therapies and Problem Solving Therapies. They have shown to impact upon a wide range of outcomes, including psychological distress, pain, physical health, medication adherence, and family outcomes. There is increasing recognition that the holistic goals of the child and family should be prioritised, and that interventions and outcomes should reflect these goals. A focus on holistic goals in therapy can be achieved through a combination of personalised goal-based outcomes in addition to symptom-based measures.
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Affiliation(s)
- Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK.
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK.
| | - Mhairi McKenzie Smith
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK.
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43
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Shen Y, Zhang M, Wang Y, Wang L, Xu X, Xiao G, Chen J, Zhang T, Zhou N. Subjective sleep disturbance in Chinese adults with epilepsy: Associations with affective symptoms. Epilepsy Res 2017; 135:150-157. [PMID: 28697489 DOI: 10.1016/j.eplepsyres.2017.06.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/08/2017] [Accepted: 06/25/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND As well as being a very common neurological disease worldwide, epilepsy significantly impairs patients' emotional, behavioral, and cognitive functioning. Sleep disturbances are the most frequent complaint in patients with epilepsy. The present study assesses the impact of a range of affective symptoms on subjective sleep quality and sleep disturbances in Chinese adults with epilepsy. METHODS Adults with epilepsy who visited our epilepsy clinic from July 2015 to March 2016 were enrolled in our study. Both patients and healthy controls completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Mini-mental State Examination (MMSE). Subjective sleep quality and sleep disturbances were examined with regard to self-reported symptoms of depression and anxiety, seizure-related factors, and demographic factors. RESULTS The PSQI scores and ISI scores of patients were significantly higher (indicating lower quality sleep and more serious insomnia) than those of the control group. Symptoms associated with depression and anxiety were independently related to impaired subjective sleep quality and insomnia. Affective symptoms explained more of the variance in PSQI scores and ISI scores than did seizure-related or demographic variables. In addition, these variables also seemed to be less powerful contributing factors to subjective sleep quality and insomnia than affective symptoms, several seizure-related factors, such as seizure control, partial seizures and duration of epilepsy, which are also significantly associated with subjective sleep quality and insomnia. In addition, use of lamotrigine (LTG) was also associated with insomnia and use of clonazepam (CZP) and phenobarbital (PB) with daytime sleepiness in patients with epilepsy. CONCLUSION Chinese adults with epilepsy have poorer self-reported subjective sleep quality and a higher prevalence of insomnia than the control group. Depressive- and anxiety-related symptoms independently exert an adverse effect on the subjective sleep quality and insomnia of patients. In addition, seizure control, partial seizures, and the duration of epilepsy affect the quality of sleep and insomnia in patients, but seem less powerful predictors of sleep quality and insomnia than affective symptoms. Early identification and treatment of affective symptoms is of great importance in improving the sleep quality and insomnia of patients with epilepsy.
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Affiliation(s)
- Yeru Shen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Mengmeng Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Lanlan Wang
- Anhui Provincial Stereotactic Neurosurgical Institute, Anhui Provincial Hospital, Hefei, Anhui Province, PR China
| | - Xiangjun Xu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| | - Gairong Xiao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Jing Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Ting Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Nong Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China.
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Nogueira MH, Yasuda CL, Coan AC, Kanner AM, Cendes F. Concurrent mood and anxiety disorders are associated with pharmacoresistant seizures in patients with MTLE. Epilepsia 2017; 58:1268-1276. [PMID: 28555776 DOI: 10.1111/epi.13781] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate whether mood disorders (MD) and anxiety disorders (AD) are associated with seizure control in patients with mesial temporal lobe epilepsy (MTLE). We compared patients without any current psychiatric disorder, patients with current MD and/or AD, patients with subsyndromic depression episodes (SSDE) and anxiety episodes (SSAE), and patients with family psychiatric history. METHODS In a cross-sectional study, we included 144 consecutive patients with MTLE (82 pharmacoresistant and 62 treatment-responsive patients). Every patient underwent a psychiatric evaluation including the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis I (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Interictal Dysphoric Disorder Inventory (IDDI). Patients were divided into four groups: PsychNeg (G1, n = 61), current SSDE and SSAE (G2, n = 26), Current MD or AD (G3, n = 25), and current mixed MD/AD (G4, n = 32). RESULTS Among patients with pharmacoresistant MTLE, 68.3% (56/82) experienced symptoms of depression and/or anxiety (G2, G3, and G4) (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.41-5.53, p < 0.01). Patients with mixed MD/AD (G4, n = 24/32) were more likely to have pharmacoresistant MTLE (OR 4.04, 95% CI 1.57-10.42, p < 0.01) than psychiatric asymptomatic patients (G1, n = 26/61), and their seizure frequency was significantly higher (p < 0.01). Positive family psychiatric history was more frequent in pharmacoresistant patients (n = 27/82, OR 2.28, 95% CI 1.02-5.05, p = 0.04). Finally, 31.6% of patients with MD and or AD were not receiving psychiatric treatment. SIGNIFICANCE Identification of comorbid MD/AD and of family psychiatric history is of the essence in patients with MTLE, as they appear to be associated with worse seizure control.
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Affiliation(s)
- Mateus H Nogueira
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Clarissa L Yasuda
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Ana C Coan
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Fernando Cendes
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
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45
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Novakova B, Harris PR, Reuber M. Diurnal patterns and relationships between physiological and self-reported stress in patients with epilepsy and psychogenic non-epileptic seizures. Epilepsy Behav 2017; 70:204-211. [PMID: 28432961 DOI: 10.1016/j.yebeh.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/23/2017] [Accepted: 03/04/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE Patients with epilepsy and those with psychogenic non-epileptic seizures (PNES) experience high levels of stress and stress is one of the most frequently self-identified seizure precipitants. Although stress is a multifaceted phenomenon, few studies have systematically examined its different components in patients with seizures. The aim of this study was therefore to describe diurnal patterns of psychological and physiological measures of stress in patients with epilepsy and patients with PNES, and explore their relationships to each other in order to improve our understanding of the mechanisms underlying stress and seizure occurrence in these patients. METHOD A range of stress markers including self-reported stress, salivary cortisol, and heart rate variability (HRV) were explored in adult patients with refractory epilepsy (N=22) and those with PNES (N=23) undergoing three- to five-day video-telemetry. RESULTS A diurnal pattern was observed in the physiological measures, characterized by higher levels of physiological arousal in the mornings and lower levels at night in both patients with epilepsy and PNES. The physiological measures (cortisol and HRV) were associated with each other in patients with epilepsy; no close relationship was found with self-reported stress in either of the two patient groups. CONCLUSION The findings contribute to and expand on previous studies of the patterns of stress in patients with seizures. The results also indicate a discrepancy between patients' physiological responses and their subjective stress perceptions, suggesting that simple self-reports cannot be used as a proxy of physiological arousal in patients with seizures and stress. Stress in these patient groups should be studied using a combination of complementary measures.
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Affiliation(s)
- Barbora Novakova
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
| | - Peter R Harris
- School of Psychology, University of Sussex, Sussex House, Falmer, Brighton BN1 9RH, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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Wang Z, Guo C, Chen G, Zhang L, Wen X, Zheng X. Mutual associations between intellectual disability and epilepsy-related psychiatry disability: Population-based study. Medicine (Baltimore) 2017; 96:e6831. [PMID: 28489764 PMCID: PMC5428598 DOI: 10.1097/md.0000000000006831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Epilepsy is the third-leading cause of psychiatry disability in China, and intellectual disability (ID) is also 1 major type of disabilities in China. This study estimates the prevalence of comorbidities with ID and epilepsy-related psychiatry disability (EPD) and examines mutual associations within ID and EPD.Data were taken from the Second China National Sample Survey on Disability, which was a nationally representative, population-based survey. To derive a nationally representative sample, the survey used multistage, stratified, cluster random sampling with probability proportional to size. The disabled people who had ID and EPD based on the World Health Organization International Classification of Functioning, Disability, and Health and the International Statistical Classification of Diseases. The cox-proportional hazards model was used to examine the associations between ID and EPD considering the happened sequence of ID and EPD.The prevalence of ID with EPD was 0.14 (95% confidence interval: 0.09-0.19) per 1000 people. Age was strongly associated with the risk of EPD, which was diagnosed after ID, especially among young ID population. Except for age, other variables were also associated between ID and EPD considering sequence of ID and EPD.This study is the first national study to explore mutual associations with ID and EPD and highlights the young ID children with high risk of development of epilepsy. To address the challenge of ID with EPD disability in China, the government should adjust its strategies for healthcare systems to prevent disability.
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47
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Ramos-Perdigués S, Baillés E, Mané A, Carreño M, Donaire A, Rumia J, Bargalló N, Boget T, Setoain X, Valdes M, Pintor L. A prospective study contrasting the psychiatric outcome in drug-resistant epilepsy between patients who underwent surgery and a control group. Epilepsia 2016; 57:1680-1690. [PMID: 27562413 DOI: 10.1111/epi.13497] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Psychiatric morbidity in drug-resistant epilepsy is frequent and has a negative influence on quality of life. Surgery is proven to be the best therapeutic alternative for treating seizures. However, it is inconclusive with the current evidence whether surgery, per se, is a risk factor or promotes amelioration of psychiatric disorders. Until now, most studies have been cross-sectional with small or heterogeneous groups. In addition, the few prospective studies did not have an identical control group. The present study aims to clarify the role of surgery in psychopathologic alterations. METHODS We analyzed, through a prospective case-control study, the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery and those who continued with pharmacologic treatment due to not being suitable for surgery. The assessments were performed during presurgical evaluation and 6 months after surgery. We studied psychiatric changes for each group, compared differences between groups, and also analyzed de novo and remission cases. Finally, we determined associated factors for postsurgical psychiatric disturbances. RESULTS The surgical group experienced a significant decrease in psychopathologic alterations in comparison with the control group. In addition, distress perception of surgical patients also improved, whereas it did not decrease in the control group. Patients who underwent surgery presented a decrease in depressive and anxiety symptoms, whereas the nonsurgical group increased its anxiety levels. De novo disturbances that appeared after surgery were less frequent than in nonsurgical patients. We observed significant favorable outcomes considering de novo versus remission cases for anxiety, depression, and total symptoms only in the surgical group. The two main predictors for psychiatric disorders after surgery were presurgical psychiatric functioning and surgery. SIGNIFICANCE Provides evidence that surgery improves psychiatric functioning in drug-resistant epilepsy through a prospective controlled study.
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Affiliation(s)
| | - Eva Baillés
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Mané
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar and Foundation IMIM, Barcelona, Spain.,Center for Biomedical Research in Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jordi Rumia
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Nuria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Manuel Valdes
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
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Altınöz AE, Tosun Meriç O, Tosun Altınöz Ş, Eşsizoğlu A, Coşar B. Psychiatric disorders comorbid with epilepsy in a prison sample. Seizure 2016; 40:133-5. [PMID: 27423133 DOI: 10.1016/j.seizure.2016.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Epilepsy is an extremely widespread and serious neurological disease. Although comorbidities of psychiatric disorders are prevalent in epilepsy patients, quite often this coexistence could be overlooked. Studies in this area demonstrated that depression, anxiety disorders and schizophrenia are the most common psychiatric disorders accompanying epilepsy. Mental health problems are known to be more common in prisoners compared to general population. The present study aims to demonstrate the psychiatric comorbidities in prisoners diagnosed with epilepsy. METHOD In this study, demographic data and the psychiatric comorbidity of 200 patients who were diagnosed with epilepsy by a neurologist at Ankara Penal Institution Campus State Hospital between January 2013 and January 2014 were analyzed retrospectively. RESULTS The mean age of study population was 32.6±10.1years. 181 of these patients were male (90.5%). 81 of 200 patients (40.5%) had a comorbid psychiatric disorder. The most common comorbid psychiatric disorders were depression (18.5%), anxiety (11%), and personality disorders (11%), respectively. CONCLUSION The most common psychiatric comorbid disorders among prisoners diagnosed with epilepsy were depression and anxiety as general population with epilepsy whereas some disorders, personality disorder, substance dependence and bipolar affective disorders, were found to be more common among prisoners compared to the general population with epilepsy. It is crucial to question psychiatric symptoms and comorbidities while evaluating the patients with epilepsy, especially among prisoners.
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Affiliation(s)
- Ali Ercan Altınöz
- Department of Psychiatry, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Olcay Tosun Meriç
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Altan Eşsizoğlu
- Department of Psychiatry, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Behçet Coşar
- Department of Psychiatry, Faculty of Medicine, Gazi University, Ankara, Turkey
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50
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Abstract
Anxiety disorders are frequent, though probably underdiagnosed, comorbidities in epilepsy. Epilepsy and anxiety may share common neurobiological correlates as shown in animal models and suggested by studies demonstrating anxiety disorders before the manifestation of epilepsy. Comorbid anxiety disorders have a major impact on the affected patients' quality of life and may increase the risk for suicidality. Successful treatment of the epilepsy may alleviate anxiety symptoms. Treatment of anxiety is based on selective serotonin reuptake inhibitors, benzodiazepines (although only as second-line choices), and psychotherapy. Specific AEDs (especially pregabalin) have been shown to have anxiolytic properties. This paper is aimed at reviewing anxiety disorders in patients with epilepsy discussing current scientific evidence about pathophysiology, clinical aspects, and treatment strategies.
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Affiliation(s)
- Christian Brandt
- Department of General Epileptology, Bethel Epilepsy Centre, Mara Hospital, Maraweg 21, D-33617 Bielefeld, Germany.
| | - Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust, London, UK; Institute of Medical and Biomedical Sciences, St George's University of London, London, UK.
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