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Faught E, Besson H, D'Souza W, Klein P, Reuber M, Rosenow F, Salas-Puig J, Insuga VS, Steinhoff BJ, Strzelczyk A, Szaflarski JP, Bourikas D, Daniels T, Floricel F, Friesen D, Laloyaux C, Villanueva V. Brivaracetam effectiveness and tolerability in older and younger adults with epilepsy: EXPERIENCE, a pooled analysis of international data from retrospective studies. Epilepsy Behav 2024; 158:109922. [PMID: 38970892 DOI: 10.1016/j.yebeh.2024.109922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
This analysis assessed the effectiveness and tolerability of brivaracetam (BRV) in older (≥65 years of age) and younger (≥16 to <65 years of age) adults with epilepsy. This was a subgroup analysis from EXPERIENCE/EPD332, a pooled analysis of individual patient records from multiple independent, non-interventional studies of patients with epilepsy starting BRV in Australia, Europe, and the United States. Included patients had ≥6 months of follow-up data. Outcomes included responders (≥50 % reduction from baseline in seizure frequency), seizure freedom (no seizures within 3 months before the time point), and continuous seizure freedom (no seizures from baseline) at 12 months; BRV discontinuation during the whole study follow-up; and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Patients with missing data after BRV discontinuation were deemed non-responders/not seizure-free. Analysis populations included the Full Analysis Set (FAS; patients who received ≥1 BRV dose and had seizure type and age documented at baseline) and the modified FAS (FAS patients who had ≥1 seizure recorded during baseline). The FAS was used for all outcomes except seizure reduction. The FAS included 147 (8.9 %) patients aged ≥65 years and 1497 (91.1 %) aged ≥16 to <65 years. Compared with the younger subgroup, patients aged ≥65 years had a longer median epilepsy duration (33.0 years [n = 144] vs 17.0 years [n = 1460]) and lower median seizure frequency at index (2.0 seizures/28 days [n = 129] vs 4.0 seizures/28 days [n = 1256]), and less commonly had >1 prior antiseizure medication (106/141 [75.2 %] vs 1265/1479 [85.5 %]). At 12 months, a numerically higher percentage of patients aged ≥65 years versus the younger subgroup achieved ≥50 % seizure reduction (46.5 % [n = 71] vs 36.0 % [n = 751]), seizure freedom (26.0 % [n = 100] vs 13.9 % [n = 1011]), and continuous seizure freedom (22.0 % [n = 100] vs 10.7 % [n = 1011]). During the whole study follow-up, 43/147 (29.3 %) patients aged ≥65 years and 508/1492 (34.0 %) aged ≥16 to <65 years discontinued BRV. The incidence of TEAEs since the prior visit was similar in both subgroups at 3 months (≥65 years vs ≥16 to <65 years: 38/138 [27.5 %] vs 356/1404 [25.4 %]), 6 months (19/119 [16.0 %] vs 176/1257 [14.0 %]), and 12 months (8/104 [7.7 %] vs 107/1128 [9.5 %]). This real-world analysis suggests BRV was effective in patients aged ≥65 years and ≥16 to <65 years, with numerically higher effectiveness in the older subgroup. BRV was well tolerated in both subgroups.
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Affiliation(s)
- Edward Faught
- Emory University, Emory Epilepsy Center, 12 Executive Park Drive NE, Atlanta, GA 30329, United States.
| | - Hervé Besson
- UCB Pharma, Hoge Mosten, 2, 4822 NH Breda, Netherlands.
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, VIC 3065, Australia.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, 6410 Rockledge Drive, Suite 610, Bethesda, MD 20817, United States.
| | - Markus Reuber
- The University of Sheffield, Department of Neuroscience, Academic Neurology Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
| | - Felix Rosenow
- Goethe University Frankfurt, University Hospital Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Schleusenweg 2-16, Haus 95, 60528 Frankfurt am Main, Germany.
| | - Javier Salas-Puig
- Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Avenida de Menéndez Pelayo, 65, Retiro, 28009 Madrid, Spain.
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Landstr. 1, 77694 Kehl-Kork and Medical Faculty, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
| | - Adam Strzelczyk
- Goethe University Frankfurt, University Hospital Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Schleusenweg 2-16, Haus 95, 60528 Frankfurt am Main, Germany.
| | - Jerzy P Szaflarski
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, SC 350, 1720 2nd Ave South, Birmingham, AL 35294, United States.
| | | | - Tony Daniels
- UCB Pharma, 4000 Paramount Parkway, Suite 200, Morrisville, NC 27560, United States.
| | - Florin Floricel
- UCB Pharma, Alfred-Nobel-Str. 10, 40789 Monheim am Rhein, Germany.
| | - David Friesen
- UCB Pharma, 216 Bath Road, Slough SL1 3WE, United Kingdom.
| | - Cédric Laloyaux
- UCB Pharma, Allée de la Recherche, 60, 1070 Brussels, Belgium.
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EPICARE Member, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain.
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Drapier D. Schizophrenia and epileptic comorbidity. Rev Neurol (Paris) 2024; 180:308-313. [PMID: 38503587 DOI: 10.1016/j.neurol.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
Epileptic seizures have been widely considered as a complication of external or iatrogenic factors in schizophrenia. However, epidemiologic, neurodevelopmental and genetic data have changed regards on this topic considering the complexity of the bidirectional link between epilepsy and schizophrenia. We will examine these data constituting the pathophysiological aspects of this particular association and detail the particular impact of antipsychotics on the occurence of epileptic seizure in schizophrenia as well as the management strategies.
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Affiliation(s)
- D Drapier
- University of Rennes, rue du Thabor, 35000 Rennes, France; Centre hospitalier Guillaume-Regnier, 108, avenue Général-Leclerc, 35703 Rennes, France.
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3
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Peek SI, Twele F, Meller S, Packer RMA, Volk HA. Epilepsy is more than a simple seizure disorder: Causal relationships between epilepsy and its comorbidities. Vet J 2024; 303:106061. [PMID: 38123062 DOI: 10.1016/j.tvjl.2023.106061] [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: 06/05/2021] [Revised: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
This review draws connections between the pathogenesis of canine epilepsy and its most commonly recognised comorbidities: cognitive impairment (CI), attention deficit hyperactivity disorder (ADHD)-like behaviour, fear and anxiety. Uni/bidirectional causalities and the possibility of a common aetiology triggering both epilepsy and the associated diseases are considered. Research on this topic is sparse in dogs, so information has been gathered and assessed from human and laboratory animal studies. Anatomical structures, functional connections, disrupted neurotransmission and neuroinflammatory processes collectively serve as a common foundation for epilepsy and its comorbidities. Specific anatomical structures, especially parts of the limbic system, such as the amygdala and the hippocampus, are involved in generating seizures, as well as cognitive- and behavioural disorders. Furthermore, disturbances in inhibitory and excitatory neurotransmission influence neuronal excitability and networks, leading to underlying brain dysfunction. Functional magnetic resonance imaging (fMRI), interictal epileptiform discharges (IEDs), and electroencephalography (EEG) have demonstrated functional brain connections that are related to the emergence of both epilepsy and its various comorbidities. Neuroinflammatory processes can either cause or be a consequence of seizures, and inflammatory mediators, oxidative stress and mitochondrial dysfunction, can equally evoke mood disorders. The extensive relationships contributing to the development and progression of seizures and comorbid cognitive and behavioural conditions illustrate the complexity of the disease that is epilepsy.
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Affiliation(s)
- Saskia I Peek
- 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
| | - Sebastian Meller
- 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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Sullivan-Baca E, Rehman R, Towne AR, Haneef Z. Psychiatric co-morbidity of drug-resistant epilepsy in Veterans. Epilepsy Behav 2023; 139:109059. [PMID: 36577335 DOI: 10.1016/j.yebeh.2022.109059] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/24/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Psychiatric conditions are frequently co-morbid in epilepsy and studies examining Veterans with epilepsy suggest this population may present with unique psychiatric and clinical features Drug-resistant epilepsy (DRE) may confer a greater risk of psychiatric dysfunction; however, there is a paucity of literature documenting this. To expand our clinical understanding of Veterans with DRE, we assessed a comprehensive Veterans Health Administration (VHA)-wide sample, describing psychiatric conditions, medications, and healthcare utilization. METHODS Psychiatric and hospitalization data were collected on 52,579 Veterans enrolled in VHA healthcare between FY2014-2ndQtr.FY2020 from the VHA Corporate Data Warehouse administrative data. Data examined include psychiatric diagnosis, psychotropic medication use, and utilization of hospital services. RESULTS At least one psychiatric diagnosis was present in 70.2% of patients, while 49.8% had two or more diagnoses. Depression (51.7%), posttraumatic stress disorder (PTSD) (38.8%), and anxiety (38.0%) represented the most common psychiatric co-morbidities. Psychiatric medication use was present in 73.3%. Emergency room (ER) visits were highest in those with suicidality (mean 14.9 visits), followed by bipolar disorder (10.3), and schizophrenia (12.1). Psychiatric-related hospitalizations were highest for schizophrenia (mean 2.5 admissions) and bipolar disorder (2.3). Females had more psychiatric diagnoses (2.4 vs. 1.6, p < 0.001), psychiatric medications (3.4 vs. 2.3, p < 0.001), and ER utilization than males (6.9 vs. 5.5, p < 0.001). SIGNIFICANCE A substantial psychiatric burden exists among Veterans with DRE. Compared to prior epilepsy literature, results suggest that Veterans with DRE evidence more prevalent psychiatric comorbidity, emergency care usage, and inpatient psychiatric admissions. Females were especially impacted, with greater rates of psychiatric conditions and treatment. Considering the relationship of psychiatric comorbidities in epilepsy with psychosocial functioning and quality of life, our findings highlight the need for screening and provision of services for those with DRE.
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Affiliation(s)
- Erin Sullivan-Baca
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Rizwana Rehman
- Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, United States; Epilepsy Centers of Excellence, Veteran's Health Administration, United States.
| | - Alan R Towne
- Epilepsy Centers of Excellence, Veteran's Health Administration, United States; Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Epilepsy Centers of Excellence, Hunter Holmes McGuire VA Medical Center, United States.
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Epilepsy Centers of Excellence, Veteran's Health Administration, United States; Neurology Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, United States.
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Revdal E, Morken G, Bakken IJ, Bråthen G, Landmark CJ, Brodtkorb E. Bidirectionality of antiseizure and antipsychotic treatment: A population-based study. Epilepsy Behav 2022; 136:108911. [PMID: 36126553 DOI: 10.1016/j.yebeh.2022.108911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To study the prevalence and directionality of comorbid epilepsy and psychosis in Norway. METHODS The Norwegian Prescription Database (NorPD) provided individual-based information on all antiseizure medications (ASMs) and antipsychotic drugs (APDs) dispensed during 2004-2017. Subjects were ≥18 years of age at the end of the study period. Diagnosis-specific reimbursement codes from the 10th revision of the International Classification of Diseases/2nd edition of the International Classification of Primary Care (ICD-10/ICPC-2) combined with ATC codes were used as indicators of diagnosis. Subjects had collected ASMs for epilepsy or APDs for psychosis at least four times, at least once issued with an ICD-10 code from the specialist healthcare service. Directionality was analyzed in subjects receiving both treatments. To reduce prevalent comorbidity bias, we employed a four-year comorbidity-free period (2004-2007). The use of specific ASMs and APDs was analyzed. RESULTS A total of 31,289 subjects had collected an ASM for epilepsy at least four times, 28,889 an APD for psychosis. Both the prevalence of treatment for epilepsy and of treatment for psychosis was 0.8%. Further, 891 subjects had been treated for both conditions; 2.8% with epilepsy had been treated for psychosis, and 3.1% with psychosis had been treated for epilepsy. Among 558 subjects included in the analyses of directionality, 56% had collected the first APD before an ASM, whereas 41% had collected an ASM first. During the last year prior to comorbidity onset, levetiracetam, topiramate, or zonisamide had been used for epilepsy by approximately 40%, whereas olanzapine and quetiapine were most used in patients with psychosis, and clozapine in 13%. CONCLUSION The proportion of patients with prior antipsychotic treatment at onset of epilepsy is higher than previously acknowledged, as demonstrated in this nation-wide study. Apart from a shared neurobiological susceptibility, the bidirectionality of epilepsy and psychosis may be influenced by various environmental factors, including the interaction of pharmacodynamic effects. APDs may facilitate seizures; ASMs may induce psychiatric symptoms. In patients with combined treatment, these potential drug effects should receive ample attention, along with the psychosocial consequences of the disorders. A prudent multi-professional approach is required.
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Affiliation(s)
- Eline Revdal
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Gunnar Morken
- Department of Psychiatry, St. Olav University Hospital, Trondheim, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Geir Bråthen
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Cecilie Johannesen Landmark
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway; The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway; Department of Pharmacology, Oslo University Hospital, Oslo, Norway.
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
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6
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Wang J, Zhang Y, Zhang H, Wang K, Wang H, Qian D, Qi S, Yang K, Long H. Nucleus accumbens shell: A potential target for drug-resistant epilepsy with neuropsychiatric disorders. Epilepsy Res 2020; 164:106365. [PMID: 32460115 DOI: 10.1016/j.eplepsyres.2020.106365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
The nucleus accumbens (NAc) is an important component of the ventral striatum, involving motivational and emotional processes, limbic-motor interfaces. Recently, experimental and clinical data have shown that NAc, particularly NAc shell (NAcs), participates in ictogenesis and epileptogensis in drug-resistant epilepsy (DRE). Therefore, we summarize the existing literature on NAcs and potential role in epilepsy, from the bench to the clinic. Connection abnormalities between NAcs and remainings, degeneration of NAc neurons, and an aberrant distribution of neuroactive substances have been reported in patients with DRE. These changes may be underlying the pathophysiological mechanism of the involvement of NAcs in DRE. Furthermore, alterations in NAcs may also be involved in neuropsychiatric disorders in patients with DRE. These observational studies demonstrate the multiple properties of NAcs and the complex relationship between the limbic system and DRE with neuropsychiatric disorders. NAcs can be a potential target for DBS and stereotactic lesioning to manage DRE with neuropsychiatric disorders. Future studies are warranted to further clarify the role of NAcs in epilepsy.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China.
| | - Yuzhen Zhang
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Henghui Zhang
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Kewan Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Hongxiao Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Dadi Qian
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Kaijun Yang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China.
| | - Hao Long
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China.
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7
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Salpekar JA, Mula M. Common psychiatric comorbidities in epilepsy: How big of a problem is it? Epilepsy Behav 2019; 98:293-297. [PMID: 30149996 DOI: 10.1016/j.yebeh.2018.07.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
Psychiatric illness and epilepsy commonly co-occur in adults and in children and adolescents. Theories of comorbidity are complex, but recurring associations between the conditions suggest overlap that is more than simple co-occurrence. Common underlying pathophysiology may imply that epilepsy itself may constituently include psychiatric symptoms. Conditions such as depression or cognitive difficulties commonly occur and in some cases, are considered to be associated with specific epilepsy characteristics such as localization or seizure type. Regardless of etiologic attributions to psychiatric comorbidity, it is clear today that treatment for epilepsy needs to target psychiatric illness. In many cases, quality-of-life improvements depend more upon addressing psychiatric symptoms than seizures themselves. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
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Affiliation(s)
- Jay A Salpekar
- Kennedy Krieger Institute, Johns Hopkins University, USA.
| | - Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London, United Kingdom; Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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8
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Zoppi M, Tedrus GMAS, Laloni DT. Stigma, emotional aspects, and psychological symptoms in individuals with epilepsy. Epilepsy Behav 2019; 93:56-59. [PMID: 30831403 DOI: 10.1016/j.yebeh.2019.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
The relationship between stigma and psychological aspects in adults with epilepsy is poorly studied. The Stigma Scale of Epilepsy (SSE) was related to the Factorial Neuroticism Scale (FNS), Symptoms Assessment Scale-40 (SAS-40), and clinical aspects of 71 individuals with epilepsy, at a significance level of p < 0.05. Clinical and sociodemographic aspects are associated with the presence of psychological symptoms and emotional maladjustment. The occurrence of psychological symptoms in the SAS-40 was associated with uncontrolled seizures, longer illness duration, and perception of greater stigma. There was a relationship between perceived stigma, age, and epilepsy duration. In the linear regression for determining the factors that potentially affected perception of stigma, the symptom dimensions 'somatization' in the SAS-40 (p < 0.001) and the 'psychosocial maladjustment' in the FNS (p = 0.012) were included, and the clinical aspects were excluded. Psychological symptoms were associated with uncontrolled seizures and perceived stigma. Perception of stigma was associated with somatization and psychosocial maladjustment.
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Affiliation(s)
- Mariana Zoppi
- School of Psychology, Pontifícia Universidade Católica de Campinas, Brazil
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9
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Avedisova AS, Lebedeva AV, Pashnin EV, Kustov GV, Akzhigitov RG, Guekht AB. [Anxiety disorders in epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:37-44. [PMID: 30698542 DOI: 10.17116/jnevro201811810237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review is devoted to the place of anxiety disorders in the spectrum of psychiatric comorbidity in patients with epilepsy. The authors present general characteristics of anxiety manifestations and current views on the classification and qualification of anxiety disorders in such patients. Recent data show the relationship of anxiety with different forms of epilepsy, demographic and gender characteristics, localization of epileptic focus. The problem of bidirectional relationship of anxiety and epilepsy as well as the temporal relationship between anxiety and epileptic states are considered.
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Affiliation(s)
- A S Avedisova
- Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russia; Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - A V Lebedeva
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - G V Kustov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - R G Akzhigitov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - A B Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
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10
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Mula M. Pharmacological treatment of anxiety disorders in adults with epilepsy. Expert Opin Pharmacother 2018; 19:1867-1874. [DOI: 10.1080/14656566.2018.1527905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George’s University of London, London, UK
- Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
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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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12
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Rehman R, Everhart A, Frontera AT, Kelly PR, Lopez M, Riley D, Sajan S, Schooff DM, Tran TT, Husain AM. Implementation of an established algorithm and modifications for the identification of epilepsy patients in the veterans health administration. Epilepsy Res 2016; 127:284-290. [DOI: 10.1016/j.eplepsyres.2016.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
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13
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Pugh MJ, Parko K. Research using archival health care data: Let the buyer beware. Epilepsia 2015; 56:321-2. [DOI: 10.1111/epi.12873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mary Jo Pugh
- South Texas Veterans Health Care System; VA Epilepsy Center of Excellence; San Antonio Texas U.S.A
| | - Karen Parko
- San Francisco VA Medical Center; VA Epilepsy Center of Excellence; San Francisco California U.S.A
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Rehman R, Kelly PR, Husain AM, Tran TT. Characteristics of Veterans diagnosed with seizures within Veterans Health Administration. ACTA ACUST UNITED AC 2015; 52:751-62. [DOI: 10.1682/jrrd.2014.10.0241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 05/21/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Rizwana Rehman
- Southeast Epilepsy Centers of Excellence, Durham Department of Veterans Affairs Medical Center, Durham, NC
| | - Pamela R. Kelly
- Southeast Epilepsy Centers of Excellence, Durham Department of Veterans Affairs Medical Center, Durham, NC
| | - Aatif M. Husain
- Southeast Epilepsy Centers of Excellence, Durham Department of Veterans Affairs Medical Center, Durham, NC
| | - Tung T. Tran
- Southeast Epilepsy Centers of Excellence, Durham Department of Veterans Affairs Medical Center, Durham, NC
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Szilágyi T, Száva I, Metz EJ, Mihály I, Orbán-Kis K. Untangling the pathomechanisms of temporal lobe epilepsy—The promise of epileptic biomarkers and novel therapeutic approaches. Brain Res Bull 2014; 109:1-12. [DOI: 10.1016/j.brainresbull.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 12/30/2022]
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16
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Martin RC, Faught E, Richman J, Funkhouser E, Kim Y, Clements K, Pisu M. Psychiatric and neurologic risk factors for incident cases of new-onset epilepsy in older adults: Data from U.S. Medicare beneficiaries. Epilepsia 2014; 55:1120-7. [DOI: 10.1111/epi.12649] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Roy C. Martin
- Department of Neurology; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Edward Faught
- Department of Neurology; Emory University; Atlanta Georgia U.S.A
| | - Joshua Richman
- Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Ellen Funkhouser
- Division of Preventive Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Yongin Kim
- Division of Preventive Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Kay Clements
- Department of Health Services Administration; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Maria Pisu
- Division of Preventive Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
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Rühle N, Schley A, Pohley I, Kampf C, Benecke R, Rösche J. Neuropsychological deficits after a first unprovoked seizure and depressive symptoms in the week before. Epilepsy Behav 2014; 31:334-8. [PMID: 24262784 DOI: 10.1016/j.yebeh.2013.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/17/2022]
Abstract
This prospective study was performed to investigate whether verbal memory deficits are present in patients with a first unprovoked seizure irrespective of significant lesions in the brain and whether symptoms of depression were experienced by those patients in the week before the seizure. After having given informed consent, patients who presented with a first unprovoked seizure were investigated with a psychometric battery consisting of a verbal memory test, a figural memory test, a test following the Stroop paradigm, and a self-rating scale for depression in addition to the routine diagnostic work-up with EEG and MRI. The data of 53 patients aged 45years on average (33 males and 20 females) were available. Verbal memory deficits were present in 60% of the patients, and 21% of the patients delivered a self-rating that was suggestive of at least minor depression in the week before the seizure. Neither verbal memory deficits nor symptoms of depression were associated with a significant lesion of the brain. There was a significant negative correlation between immediate recall in the verbal memory test and the score in the self-rating scale for depression. Our data suggest that even at the time of the first unprovoked seizure, there is an epileptic condition of the brain, which facilitates the occurrence of verbal memory deficits and depression in the presence of an epileptogenic focus irrespective of its localization.
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Affiliation(s)
- Nicol Rühle
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Annett Schley
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Inga Pohley
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Sana Hanse-Klinikum Wismar, Störtebekerstraße 6, 23966 Wismar, Germany
| | - Christina Kampf
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Reiner Benecke
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Johannes Rösche
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany.
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Helmstaedter C, Aldenkamp AP, Baker GA, Mazarati A, Ryvlin P, Sankar R. Disentangling the relationship between epilepsy and its behavioral comorbidities - the need for prospective studies in new-onset epilepsies. Epilepsy Behav 2014; 31:43-7. [PMID: 24333577 DOI: 10.1016/j.yebeh.2013.11.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/04/2013] [Accepted: 11/09/2013] [Indexed: 12/20/2022]
Abstract
It has been long recognized that there is more to epilepsy than seizures. The prevalence of such neurobehavioral abnormalities as cognitive and mood disorders, autism spectrum disorder, and attention deficit and hyperactivity disorder (ADHD) is significantly higher among patients with epilepsy than in the general population. A long-held view that comorbidities of epilepsy represent mere epiphenomena of seizures has undergone substantial transformation during the past decade, as emerging clinical evidence and experimental evidence suggest the involvement of specific neurobiological mechanisms in the evolution of neurobehavioral deficits in patients with epilepsy. Developmental aspects of both epilepsy and its comorbidities, as well as the frequently reported reciprocal connection between these disorders, both add other dimensions to the already complex problem. In light of progress in effective seizure management in many patients with epilepsy, the importance of neurobehavioral comorbidities has become acute, as the latter are frequently more detrimental to patients' quality of life compared with seizures. This calls for a serious increase in efforts to effectively predict, manage, and ideally cure these comorbidities. Coordinated multicenter clinical, translational, and basic research studies focusing on epidemiology, neuropsychology, neurophysiology, imaging, genetics, epigenetics, and pharmacology of neurobehavioral comorbidities of epilepsy are absolutely instrumental for ensuring tangible progress in the field. Clinical research should focus more on new-onset epilepsy and put particular emphasis on longitudinal studies in large cohorts of patients and groups at risk, while translational research should primarily focus on the development of valid preclinical systems which would allow investigating the fundamental mechanism of epilepsy comorbidities. The final goal of the described research efforts would lie in producing an armamentarium of evidence-based diagnostic tools and therapeutic interventions which would at minimum mitigate and at maximum prevent or abolish neurobehavioral comorbidities of epilepsy and, thus, improve the quality of life of those patients with epilepsy who suffer from the said comorbidities.
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Affiliation(s)
| | - A P Aldenkamp
- Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Dept of Neurology Maastricht University Medical Centre, Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
| | - G A Baker
- Division of Neurosciences, University of Liverpool, Liverpool, UK
| | - A Mazarati
- Department of Pediatrics, Neurology Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752, USA
| | - Ph Ryvlin
- Department of Functional Neurology and Epileptology, Neurological Hospital, CTRS-INSERM IDEE, Institut Des Epilepsies de l'Enfant et de l'adolescent, Hospices Civils de Lyon, INSERM U821, Universite Claude Bernard Lyon 1, Lyon, France
| | - R Sankar
- Department of Pediatrics, Neurology Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752, USA
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Longitudinal association between epilepsy and schizophrenia: a population-based study. Epilepsy Behav 2014; 31:291-4. [PMID: 24269029 DOI: 10.1016/j.yebeh.2013.10.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/21/2013] [Accepted: 10/23/2013] [Indexed: 11/23/2022]
Abstract
A large number of studies have reported an association between epilepsy and major psychiatric conditions. This study investigated the association between epilepsy and later schizophrenia, utilizing a historical-prospective, population-based design. Of the 861,062 17-year-old male adolescents consecutively screened by the Israeli Draft Board and found free of major mental illness, 0.06% suffered from severe, treatment-refractory epilepsy, 0.25% had treated, controlled epilepsy, and 0.16% had a history of seizures which had abated 5 or more years prior to screening. Hospitalization for schizophrenia was ascertained through the Israeli National Psychiatric Hospitalization Case Registry, with an average follow-up of 9.6±1.0years (range: 1.0-10.0years). Risk of hospitalization was calculated using Cox regression analyses, compared to socioeconomic-adjusted risk of hospitalization in the general population of male adolescents. Among adolescents whose epilepsy was nonresponsive to medication, the adjusted risk of hospitalization was significantly increased for schizophrenia (HR=3.89, 95% CI=1.75-89.67). Male adolescents with successfully treated epilepsy were not at increased risk for schizophrenia. Male adolescents with severe, treatment-refractory epilepsy are at increased risk of later schizophrenia. Future studies attempting to understand the biology of this association might focus on this subset of patients, and these patients should be monitored for the appearance of psychosis.
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Responsive neurostimulation for the treatment of medically intractable epilepsy. Brain Res Bull 2013; 97:39-47. [PMID: 23735806 DOI: 10.1016/j.brainresbull.2013.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/10/2013] [Accepted: 05/16/2013] [Indexed: 01/17/2023]
Abstract
With an annual incidence of 50/100,000 people, nearly 1% of the population suffers from epilepsy. Treatment with antiepileptic medication fails to achieve seizure remission in 20-30% of patients. One treatment option for refractory epilepsy patients who would not otherwise be surgical candidates is electrical stimulation of the brain, which is a rapidly evolving and reversible adjunctive therapy. Therapeutic stimulation can involve direct stimulation of the brain nuclei or indirect stimulation of peripheral nerves. There are three stimulation modalities that have class I evidence supporting their uses: vagus nerve stimulation (VNS), stimulation of the anterior nuclei of the thalamus (ANT), and, the most recently developed, responsive neurostimulation (RNS). While the other treatment modalities outlined deliver stimulation regardless of neuronal activity, the RNS administers stimulation only if triggered by seizure activity. The lower doses of stimulation provided by such responsive devices can not only reduce power consumption, but also prevent adverse reactions caused by continuous stimulation, which include the possibility of habituation to long-term stimulation. RNS, as an investigational treatment for medically refractory epilepsy, is currently under review by the FDA. Eventually systems may be developed to enable activation by neurochemical triggers or to wirelessly transmit any information gathered. We review the mechanisms, the current status, the target options, and the prospects of RNS for the treatment of medically intractable epilepsy.
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Pisu M, Kratt P, Faught E, Martin RC, Kim Y, Clements K, Knowlton R, Funkhouser E, Richman JS. Geographic variation of epilepsy for older Americans: how close to the geographic variation of stroke? Epilepsia 2012; 53:2186-93. [PMID: 22958112 DOI: 10.1111/j.1528-1167.2012.03640.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Given the strong association of stroke and epilepsy in older persons, and the existence of a Stroke Belt in the United States, we hypothesized that geographic variation in epilepsy prevalence would follow geographic patterns similar to stroke. METHODS We used a 2005 5% random sample of Medicare beneficiaries 65 and older in 48 U.S. contiguous states. Epilepsy was identified from claims for physician visits, hospitalizations, and outpatient procedures. Prevalence was obtained by state and county. Logistic regressions determined the independent association of the likelihood of epilepsy (prevalent or new case) and residence in Stroke Belt states, controlling for residence in highest epilepsy prevalence states, demographics (race, age, gender), comorbid conditions, cerebrovascular disease, dementia, and county characteristics. KEY FINDINGS Of 1,212,015 beneficiaries, 11.9 per 1,000 had prevalent and 2.9 new cases of epilepsy. Nine of 11 Stroke Belt states were among the 20 states with the highest epilepsy prevalence. Counties in the 10 highest epilepsy prevalence states were more likely to be large urban counties with a higher number of neurologists or neurosurgeons per capita. The higher likelihood of prevalent epilepsy cases associated with Stroke Belt residence was explained by beneficiaries' race; that associated with residence in high epilepsy prevalence states was not. The likelihood of new epilepsy cases was negatively associated with Stroke Belt residence when controlling for covariates. SIGNIFICANCE The geographic variation in epilepsy prevalence is not explained by variations in known risk factors. Further research should investigate why eastern U.S. states have higher frequency of epilepsy.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-4410, USA.
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Clarke MC, Tanskanen A, Huttunen MO, Clancy M, Cotter DR, Cannon M. Evidence for shared susceptibility to epilepsy and psychosis: a population-based family study. Biol Psychiatry 2012; 71:836-9. [PMID: 22365727 DOI: 10.1016/j.biopsych.2012.01.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/09/2012] [Accepted: 01/09/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is emerging evidence of an etiological overlap between a range of neurodevelopmental disorders, including schizophrenia and epilepsy. Here we investigate shared familial vulnerability to psychotic illness and epilepsy in a family-based study. METHODS The study population consisted of parents and their children born in Helsinki between 1947 and 1990. The Finnish Hospital Discharge Register was used to determine psychiatric and neurological outcomes in adulthood for all offspring. Parental history of psychosis and epilepsy was determined by linking the Hospital Discharge Register and the Finnish Population Register. RESULTS Our total sample comprised 9653 families and 23,404 offspring. Individuals with epilepsy had a 5.5-fold increase in the risk of having a broadly defined psychotic disorder, an almost 8.5-fold increase in the risk of having schizophrenia, and a 6.3-fold increase in the risk of having bipolar disorder. There was strong evidence of clustering of the association between epilepsy and psychosis within families. Individuals with a parental history of epilepsy had a 2-fold increase in the risk of developing psychosis, compared with individuals without a parental history of epilepsy. Individuals with a parental history of psychosis had, reciprocally, a 2.7-fold increase in the risk of having a diagnosis of generalized epilepsy, compared with individuals without a parental history of psychosis. Post hoc analyses showed that these associations were not driven by the comorbidity of epilepsy and psychosis in the parents. CONCLUSIONS These findings support recent evidence of overlapping etiological factors between epilepsy and schizophrenia, especially recent evidence of a genetic overlap between these disorders.
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Affiliation(s)
- Mary C Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Langer M, Brandt C, Löscher W. Marked strain and substrain differences in induction of status epilepticus and subsequent development of neurodegeneration, epilepsy, and behavioral alterations in rats. Epilepsy Res 2011; 96:207-24. [DOI: 10.1016/j.eplepsyres.2011.06.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/30/2011] [Accepted: 06/04/2011] [Indexed: 10/18/2022]
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Novy J, Castelao E, Preisig M, Vidal PM, Waeber G, Vollenweider P, Rossetti AO. Psychiatric co-morbidities and cardiovascular risk factors in people with lifetime history of epilepsy of an urban community. Clin Neurol Neurosurg 2011; 114:26-30. [PMID: 21955581 DOI: 10.1016/j.clineuro.2011.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/15/2011] [Accepted: 08/27/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Depression has been consistently reported in people with epilepsy. Several studies also suggest a higher burden of cardiovascular diseases. We therefore analysed psychosocial co-morbidity and cardiovascular risk factors in patients with a lifetime history of epilepsy in the PsyCoLaus study, a Swiss urban population-based assessment of mental health and cardiovascular risk factors in adults aged between 35 and 66 years. PATIENTS AND METHODS Among 3719 participants in the PsyCoLaus study, we retrospectively identified those reporting at least 2 unprovoked seizures, defined as epilepsy. These subjects were compared to all others regarding psychiatric, social, and cardiovascular risk factors data using uni- and multivariable assessments. RESULTS A significant higher need for social help (p<0.001) represented the only independent difference between 43 subjects with a history of epilepsy and 3676 controls, while a higher prevalence of psychiatric co-morbidities (p=0.015) and a lower prevalent marital status (p=0.01) were only significant on univariate analyses. Depression and cardio-vascular risk factors, as well as educational level and employment, were similar among the groups. CONCLUSIONS This analysis confirms an increased prevalence of psychosocial burden in subjects with a lifetime history of epilepsy; conversely, we did not find a higher cardiovascular risk. The specific urban and geographical location of our cohort and the age span of the studied population may account for the differences from previous studies.
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Affiliation(s)
- Jan Novy
- Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, Switzerland
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Linehan C, Tellez-Zentano J, Burneo JG, Berg AT. Future directions for epidemiology in epilepsy. Epilepsy Behav 2011; 22:112-7. [PMID: 21820360 PMCID: PMC3170446 DOI: 10.1016/j.yebeh.2011.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/05/2011] [Indexed: 11/25/2022]
Abstract
Epidemiology continues to be an important research tool in the study of epilepsy and related disorders, providing a better understanding of the frequency, causes and natural history of the disorder. But, beyond risk factors and seizure prognosis, epidemiological studies advance knowledge of many other aspects of epilepsy. Epidemiological studies are being conducted in a new environment in which high quality neuroimaging and fast through-put genomic technologies have become routine tools in clinical diagnosis and therapeutics. Epilepsy is currently understood, not as a single, homogeneous disorder, but a multitude of different clinical syndromes and disease, each with its own cause(s), natural history, and treatment implications. That is why; the comorbidites of epilepsy represent an important area, amenable to study, as they may ultimately have a greater impact on quality of life than epilepsy itself. In this document we share our thoughts on what we think are the future directions for epidemiology in epilepsy.
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Affiliation(s)
| | - José Tellez-Zentano
- Department of Medicine-Division of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - Jorge G. Burneo
- London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Anne T. Berg
- Epilepsy Center, Children's Memorial Hospital, Chicago, IL USA
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Hoppe C, Elger CE. Depression in epilepsy: a critical review from a clinical perspective. Nat Rev Neurol 2011; 7:462-72. [PMID: 21750525 DOI: 10.1038/nrneurol.2011.104] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Copeland LA, Ettinger AB, Zeber JE, Gonzalez JM, Pugh MJ. Psychiatric and medical admissions observed among elderly patients with new-onset epilepsy. BMC Health Serv Res 2011; 11:84. [PMID: 21504584 PMCID: PMC3108373 DOI: 10.1186/1472-6963-11-84] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 04/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inpatient utilization associated with incidence of geriatric new-onset epilepsy has not been characterized in any large study, despite recognized high levels of risk factors (comorbidity). METHODS Retrospective study using administrative data (Oct '01-Sep '05) from the Veterans Health Administration from a nationwide sample of 824,483 patients over age 66 in the retrospective observational Treatment In Geriatric Epilepsy Research (TIGER) study. Psychiatric and medical hospital admissions were analyzed as a function of patient demographics, comorbid psychiatric, neurological, and other medical conditions, and new-onset epilepsy. RESULTS Elderly patients experienced a 15% hospitalization rate in FY00 overall, but the subset of new-onset epilepsy patients (n = 1,610) had a 52% hospitalization rate. New-onset epilepsy was associated with three-fold increased relative odds of psychiatric admission and nearly five-fold increased relative odds of medical admission. Among new-onset epilepsy patients, alcohol dependence was most strongly associated with psychiatric admission during the first year after epilepsy onset (odds ratio = 5.2; 95% confidence interval 2.6-10.0), while for medical admissions the strongest factor was myocardial infarction (odds ratio = 4.7; 95% confidence interval 2.7-8.3). CONCLUSION From the patient point of view, new-onset epilepsy was associated with an increased risk of medical admission as well as of psychiatric admission. From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions. Finally, from a health systems perspective, the emerging picture of the epilepsy patient with considerable comorbidity and demand for healthcare resources may merit development of practice guidelines to improve coordinated delivery of care.
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Affiliation(s)
- Laurel A Copeland
- Veterans Affairs: Central Texas Veterans Health Care System, 2102 Birdcreek Drive, Temple, TX 76502, USA.
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Abstract
Epilepsy is the most common serious neurological disorder in the elderly after stroke and dementia. It may be more important for elderly people because it is intermittent and unpredictable. There is no reliable diagnostic test and so its diagnosis and management requires clinical acumen and experience. The situation is further complicated because the elderly may have many comorbidities and therefore may have many other reasons for losing consciousness. Despite their growing number, there is remarkably little research to underpin the best epilepsy management in the elderly. This article summarizes the scope of epilepsy in elderly people, highlights cerebrovascular and neurodegenerative diseases as the main underlying etiologies, explores the diagnostic challenges in this age group, including the hurdles and processes in their investigation, and examines pertinent clinical management issues.
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Affiliation(s)
- Ann Johnston
- Department of Neurology, Morriston Hospital, Swansea, UK.
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Berg AT, Caplan R, Hesdorffer DC. Psychiatric and neurodevelopmental disorders in childhood-onset epilepsy. Epilepsy Behav 2011; 20:550-5. [PMID: 21315660 PMCID: PMC3062749 DOI: 10.1016/j.yebeh.2010.12.038] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 12/12/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
Abstract
Childhood-onset epilepsy is associated with psychiatric and cognitive difficulties and with poor social outcomes in adulthood. In a prospective cohort of young people with epilepsy, we studied psychiatric and neurodevelopmental disorders and epilepsy-related characteristics, all factors that may influence long-term social outcomes. Five hundred one subjects, 159 with complicated (IQ <80 or brain lesion) and 342 with uncomplicated epilepsy, were included. Psychiatric disorders and neurodevelopmental disorders were more common in complicated epilepsy (P<0.005). In uncomplicated epilepsy, externalizing but not internalizing disorders were strongly associated with neurodevelopmental disorders. Internalizing disorders and neurodevelopmental disorders were associated with lack of 5-year remission. Type of epilepsy was not associated with neurodevelopmental disorders or psychiatric disorders. Various comorbid conditions in epilepsy cluster together and are modestly associated with imperfect seizure control. These need to be considered together in evaluating and managing young people with epilepsy and may help explain long-term social outcomes above and beyond poor seizure control.
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Affiliation(s)
- Anne T Berg
- Department of Biology, Northern Illinois University, DeKalb, IL 60115, USA.
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Honndorf S, Lindemann C, Töllner K, Gernert M. Female Wistar rats obtained from different breeders vary in anxiety-like behavior and epileptogenesis. Epilepsy Res 2011; 94:26-38. [DOI: 10.1016/j.eplepsyres.2010.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 12/17/2010] [Accepted: 12/27/2010] [Indexed: 01/24/2023]
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Neuroimaging changes in mesial temporal lobe epilepsy are magnified in the presence of depression. Epilepsy Behav 2010; 19:422-7. [PMID: 20850388 DOI: 10.1016/j.yebeh.2010.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/07/2010] [Accepted: 08/09/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate differences in gray matter volume between patients with mesial temporal lobe epilepsy (MTLE) with and without depression using voxel-based morphometry. METHOD We included 48 adults with refractory MTLE (31 women, 39.18 ± 8.4 years) and 96 healthy controls (75 women, 37.11 ± 8.9 years). For the psychiatric evaluation, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Axis I, was used for the diagnosis of depression, and the Beck Depression Inventory, for the determination of symptom intensity. All patients underwent an MRI scan. Patients were separated into two groups: those with MTLE with depression (n = 24) and those with MTLE without depression (n = 24). We performed voxel-based morphometric analysis, comparing patients with controls using the t test. RESULTS The number of areas of gray matter volume loss was higher in patients with MTLE with depression than in those with MTLE without depression. CONCLUSIONS The evidence of more widespread gray matter volume loss in patients with MTLE and depression calls our attention to the importance of timely recognition and treatment of depression in patients with MTLE and also to the bidirectional relationship between the two disorders and their frequent co-occurrence.
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